Statins Nefazodone

Specific concomitant medications or consumptions (check specific statin package insert for warnings) fibrates (especially gemfibrozil, but other fibrates too), nicotinic acid (rarely), cyclosporine, azole antifungals such as itraconazole and ketoconazole, macrolide antibiotics such as erythromycin and clarithromycin, protease inhibitors used to treat Acquired Immune Deficiency Syndrome, nefazodone (antidepressant), verapamil, amiodarone, large quantities of grapefruit juice (usually more than 1 quart per day), and alcohol abuse (independently predisposes to myopathy)... 

The antidepressant nefazodone increases the risk of rhabdomyolysis from statins (115). 

Ajmaline, ajamlicine, flecainide, fluoxetine, isoniazid, ketoconazole, lobeline, nefazodone, paroxetine, (7 )-propaphenooe, quinidine, ritonavir, "statins," yohimbine, venlafaxine... 

In a review of the FDA spontaneous reports of statin-associated rhabdomyolysis eovering the period November 1997 to March 2000, nefazodone was potentially implieated in 2 cases of rhabdomyolysis involving lovastatin. ... 

Other statins seem unlikely to interact. Note that in 2003 nefazodone was withdrawn in many countries due to cases of liver toxicity. 

The LDL-C should be kept well below 90 mg/dL, actually closer to 50 mg/dl, utilizing a low cholesterol, low animal fat diet, exercise, and a powerful statin (97). Statins have pleiotropic effects plaque stabilization, vasodilatation, anti-inflammatory, antithromotic, antiproliferative, and antioxidant (98). Most statins are metabolized via the CYP 3A4 pathway. Hence, drugs which also use the CYP 3A4 metabolic pathway, like ketoconazole, nefazodone, cyclosporine, nifedipine, felodipine. 

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