Rosiglitazone Atorvastatin

A 49-year-old man with pre-existing hepatic pathology took rosiglitazone 4 mg/day for 2 months and 8 mg/day for 5 months (114). He developed a bull face and then edema of the eyelids and neck. He had anorexia and nausea. His serum sodium was 110 mmol/1, potassium 3.3 mmol/1, chloride 81 mmol/1, cholesterol 21 mmol/1, triglycerides 33 mmol/1, and his liver enzymes were raised. Rosiglitazone was withdrawn and he was given saline and potassium, acarbose for his diabetes, spironolactone 200 mg/day for edema, and atorvastatin 10 mg/ day for hyperlipidemia. He improved over 3 weeks. 

No clinically relevant adverse interactions appear to have been reported between the statins and the sulphonylureas. One study reported an increased incidence of adverse effects with repaglinide and simvastatin, the clinical relevance of which is unclear. Most studies have shown no pharmacokinetic interaction or increased incidence of adverse effects when pioglitazone or rosiglitazone were used with atorvastatin or simvastatin. Subcutaneous exenatide modestly decreased the AUC of lovastatin, but no clear pattern of altered efficacy of statins was noted in exenatide clinical trials. 

However, in a study in healthy subjects, pioglitazone 45 mg daily did not significantly affect the pharmacokinetics of simvastatin 80 mg daily and concurrent use was well tolerated. Similarly, there was no pharmacokinetic interaction between pioglitazone 45 mg daily and atorvastatin 80 mg daily Moreover, clinical use of rosiglitazone with atorvastatin in patients with type 2 diabetes for 16 weeks was well tolerated, as was the clinical use of rosiglitazone or pioglitazone with simvastatin."... 

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