title: [Hypolipidemic agents drug interactions: approach to establish and assess its clinical significance. Structured review].
abstract: OBJECTIVE
  To carry out a structures review of drug interactions of hypolipidemic drugs and to assess their clinical relevance.
  
  
  METHODS
  Structured review of drug interactions of hypolipidemic drugs in humans through PubMed/Medline of published articles, without language restrictions and with full text access until June 30th of 2012. The following Mesh terms were used: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). The information was completed with those articles considered to be relevant. Finally, a method was used to assess the clinical relevance of the interaction, based on the likelihood of occurrence and the severity of the effect of the interaction.
  
  
  RESULTS
  849 publications were gathered, of which 243 references were selected, among which 189 interactions were identified. Thirty-three of them were considered of very high risk (level 1) and 42 of high risk (level 2), basically associated to increased risk for rhabdomyolisis. Enzymatic inhibition of CYP450 was the most common mechanism for these interactions.
  
  
  CONCLUSIONS
  Of the interactions identified in patients on hypolipidemic drugs, 60.3% (128/189) are clinically relevant (very high or high risk), mainly associated to the occurrence of rhabdomyolisis. Most of these interactions are attributed to simultaneous use of CYP3A4 inhibitors. Therefore, statins metabolized through CYP3A4 (simvastatin, lovastatin and atorvastatin) are the ones with the highest number of clinically relevant interactions.
authors.affiliation: Grupo de investigación, Promoción y Prevención Farmacéutica. Universidad de Antioquia. Medellín. Colombia. Grupo de Investigación en Atención Farmacéutica. Universidad de Granada. Granada. España.
authors.forename: D
authors.initials: D
authors.lastname: Franco
authors.forename: Y
authors.initials: Y
authors.lastname: Henao
authors.forename: M
authors.initials: M
authors.lastname: Monsalve
authors.forename: F
authors.initials: F
authors.lastname: Gutiérrez
authors.forename: J
authors.initials: J
authors.lastname: Hincapie
authors.forename: P
authors.initials: P
authors.lastname: Amariles
mesh_terms: D065607:Cytochrome P-450 Enzyme Inhibitors; D004347:Drug Interactions; D058607:Fibric Acids / Q000009:adverse effects; D018565:Food-Drug Interactions; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects; D000960:Hypolipidemic Agents / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced
chemical_list: D065607:Cytochrome P-450 Enzyme Inhibitors; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents