Drug interactions statins

Bellosta S, Corsini A (2012) Statin drug interactions and related adverse reactions. Expert Opin Drug Saf 11 933-946... 

A statin combined with a resin results in similar reductions in LDL cholesterol as those seen with ezetimibe. However, the magnitude of triglyceride reduction is less with a resin compared to ezetimibe, and this should be considered in patients with higher baseline triglyceride levels. In addition, gastrointestinal adverse events and potential drug interactions limit the utility of this combination. 

Garlic s proven mechanisms of action include (a) inhibition of platelet function, (b) increased levels of two antioxidant enzymes, catalase and glutathione peroxidase, and (c) inhibition of thiol enzymes such as coenzyme A and HMG coenzyme A reductase. Garlic s anti-hyperlipidemic effects are believed to be in part due to the HMG coenzyme A reductase inhibition since prescription medications for hyperlipidemia have that mechanism of action (statins). It is unknown whether garlic would have the same drug interactions, side effects, and need for precautions as the statins. 

A potential drug-drug interaction has also been described for the combination of gemfibrozil with several statins. Studies in healthy volunteers have demonstrated that gemfibrozil increased the AUC and Cm ix of rosuvastatin by 1.9- and 2.2-fold, respectively [43]. These results could be confirmed in vitro using Xenopus oocytes. In these experiments, gemfibrozil inhibited OATPIBl-mediated rosuvastatin transport... 

Christians, U., Jacobsen, W. and Floren, L.C., Metabolism and drug interactions of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in transplant patients are the statins mechanistically similar Pharmacol. Ther., 1998, 80, 1-34. 

Horsmans Y. Differential metabolism of statins importance in drug-drug interactions. Eur Heart J Suppl 1999 l(Suppl T) T7-T12. 

Many statins are metabolized by CYP3A4, and this and other mechanisms of drug interactions involving statins have been reviewed (69). Other drugs metabolized by CYP3A4 can greatly increase statin concentrations in the body and precipitate rhabdomyolysis. Although the statins are similar in their ability to lower cholesterol... 

Most drug interactions associated with rhabdomyolysis occur when ciclosporin is combined with simvastatin or lovastatin. It has been suggested that if a statin is to be combined with ciclosporin, pravastatin or fluvastatin should be chosen instead (80). 

Andrus MR. Oral anticoagulant drug interactions with statins case report of fluvastatin and review of the literature. Pharmacotherapy 2004 24(2) 285-90. 

A potential drug interaction between simvastatin and danazol, causing rhabdomyolysis and acute renal insufficiency, has been reported (43). Rhabdomyolysis can occur with all statins when they are used alone and particularly when they are combined with other drugs that are themselves myotoxic or that increase the concentration of the statin. Statins are particularly susceptible to the latter effect because of their metabolism by the CYP450 system and their low oral systemic availability. 

Bottorff MB. Statin safety and drug interactions clinical implications. Am J Cardiol 2006 97(suppl) 27C-31C. 

Consider potential drug interactions, some of which may be serious or even fatal, particularly in relation to the statins. 

The Summary of Product Characteristics (SPC) for each product states that all statins are contraindicated in active liver disease and in patients with persistent unexplained elevations of liver enzymes exceeding three times the upper limit of normal (ULN) [1, 2]. This is due to their extensive liver metabolism, their ability to cause raised transaminases and the risk of myopathy or rhabdomyolysis in the presence of reduced synthetic function, or to a drug interaction that reduces their metabolism. 

Herman RJ (1999) Drug interactions and the statins. CMAJ 161 1281-1286. Schachter M (2005) Chemical, pharmacokinetic and pharmacodynamic properties of statins an update. Fund Clin Pharmacol 19 117-125. 

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