title: Evaluation of impact of statin use on development of CPK elevation during daptomycin therapy.
abstract: BACKGROUND
  Because both daptomycin and statins may increase creatine phosphokinase (CPK) levels, the manufacturer of daptomycin suggests considering holding statins during daptomycin therapy. Published evidence suggests potential detrimental effects of withdrawing statin therapy.
  
  
  OBJECTIVE
  The objectives of this study were to determine the impact of concurrent statin therapy on peak CPK values, incidence of CPK elevation in patients receiving daptomycin therapy, and clinical factors associated with increased risk of developing CPK elevation.
  
  
  METHODS
  This was a single-center, retrospective cohort study of patients ≥18 years of age who received daptomycin for ≥72 hours and had ≥1 follow-up CPK during a 5-year period. A Kaplan-Meier curve was used to evaluate time to CPK elevation. Cox regression analyses were used to compare the risk of developing elevated CPK between 3 study groups: those receiving daptomycin alone, daptomycin with concurrent statin therapy, and statin therapy held while on daptomycin.
  
  
  RESULTS
  498 patients were included in the study-384 received daptomycin alone, 63 received daptomycin concurrent with statin, and 51 with statin held during daptomycin therapy. Cumulative incidence of CPK elevation was 5.1% and 12% at 7 and 14 days. Those on daptomycin and statin concurrent therapy demonstrated an approximately 2-fold risk of CPK elevation compared with those having their statin therapy held, but the overall group effect was not statistically significant (P = .17).
  
  
  CONCLUSIONS
  Our findings suggest that holding statin during daptomycin therapy may not be necessary, but may indicate need for increased frequency of CPK monitoring when these medications are used concurrently.
authors: Mayo Clinic Department of Pharmacy, Rochester, MN, USA.
authors: Melody L
authors: ML
authors: Berg
authors: Lynn L
authors: LL
authors: Estes
authors: Ross A
authors: RA
authors: Dierkhising
authors: Brian
authors: B
authors: Curran
authors: Mark J
authors: MJ
authors: Enzler
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003402:Creatine Kinase / Q000097:blood*; D017576:Daptomycin / Q000009:adverse effects*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000900:Anti-Bacterial Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003402:Creatine Kinase; D017576:Daptomycin
keywords: HMG Co-A reductase inhibitors; adverse drug reaction; creatine phosphokinase; daptomycin; drug interaction; drug safety