Tolbutamide Fluvastatin

Examples of therapeutic compounds metabolized by CYP2C9 include nonsteroidal antiinflammatory (NSAID) medications, irbesartan, naproxen, and fluvastatin (see Table 43-3). Proposed dose adjustments based on phenotype have been published for CYP2C9 drug substrates such as warfarin, glipizide, tolbutamide, and phenytoin. ... 

Cimetidine, fluconazole, fluvastatin, isoniazid, lovastatin, pravastatin, simvastatin, sulfaphenazole, tienilic acid, tolbutamide, warfarin... 

CYP2C9 20 10 Celecoxib Diclofenac Fluoxetine Fluvastatin Ibuprofen Irbesarten Naproxen Amitriptyline Phenytoin Tolbutamide Torsemide S-warfarin Rosiglitazone Amiodarone Fluconazole Fluvoxamine Fluvastatin Isoniazid Sertraline Sulfaphenazole Trimethoprin Zafirlukast Rifampin Clotrimazole Carbamazepine Hyperforin Phenobarbital Ritonavir... 

A single 1-g oral dose of tolbutamide was given to two groups of 16 healthy subjects taking fluvastatin 40 mg or simvastatin 20 mg. The pharmacokinetics of the tolbutamide were affected only to a very minor extent, and the blood glucose-lowering effects of the tolbutamide were unchanged." ... 

There is little evidence to suggest that special precautions appear to be needed by diabetic patients taking any of the pairs of sulphonylureas and statins cited here (chlorpropamide with lovastatin, or glibenclamide or tolbutamide with fluvastatin or simvastatin). However, the manufacturers of fluvastatin suggest that a serious interaction cannot be ruled out and therefore advise that the use of glibenclamide should be avoided wherever possible. ... 

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