Gemfibrozil cerivastatin interactions

B., Gemfibrozil/Cerivastatin Interaction, AAPS PharmSci. 2001, 3 (Suppl.), abstract No. 3566. 

In contrast, although in vitro studies have not shown any evidence of pharmacokinetic interactions between cerivastatin and gemfibrozil (77), there was myalgia and a marked increase in creatine kinase in a 74-year-old woman with normal renal function who took gemfibrozil 1200 mg/day 3 weeks after she started to take cerivastatin 0.3 mg/day (78). 

The British National Formulary (BNF) recommends that fibrates or nicotinic acid should not be combined with statins because of the potential for myopathy and rhabdomyolysis with this combination [54]. This is widely discussed in the medical literature. Numerous deaths have been reported and the high mortality associated with concurrent use of cerivastatin and gemfibrozil was partly instrumental in the decision to withdraw cerivastatin from the market in 2001 [34]. It appears that the high mortality in patients using concurrent gemfibrozil and cerivastatin was due to interactions at the level of glucuronidation, CYP2C8 inhibition and OATP inhibition [17, 55]. 

For instance/ the interaction between cerivastatin and gemfibrozil/ which has resulted in cases of severe rhabdomyolysiS/ is likely due to the inhibition of cerivastatin metabolism by gemfibrozil (i.e./ pharmacokinetic interaction)/ in addition to the propensity of both drugs to cause skeletal muscle toxicity (i.e./ pharmacodynamic interaction) (13-15). 

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