title: A clinician's guide to statin drug-drug interactions.
abstract: The statins are widely used worldwide to reduce risk for cardiovascular events in both the primary and secondary prevention settings. Although generally quite safe, the statins can be associated with a variety of serious side adverse effects, including myalgia, myopathy, and changes in plasma enzymes of hepatic origin. Although rare, the most serious of these is rhabdomyolysis. Several drugs can interfere with the metabolism and disposal of the statins, thereby increasing risk for adverse events. It is important that clinicians treating patients with statins be aware of the potential for drug-drug interactions between each statin and specific other drugs and take measures to prevent them. The prediction of potential drug-drug interactions derives from basic pharmacokinetic principles. Certain drug interactions are predicted by measuring the effect of interacting drugs on blood plasma concentrations of the statin. Individual patient variations resulting in part from polymorphisms in the metabolizing enzymes confound some of these predictions. Based on these known effects, a new classification for predicting statin drug interactions is proposed. This report discusses likely prescription and nonprescription interactions as well as potential alternatives for special populations.
authors.affiliation: Veterans Administration Western New York Healthcare System, State University of New York at Buffalo, Buffalo, NY 14215, USA; Department of Pharmacy, State University of New York at Buffalo, Buffalo, NY, USA; Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA. Electronic address: kenneth.kellick@va.gov.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kellick
authors.affiliation: Department of Pharmacy Practice, South College School of Pharmacy, Knoxville, TN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Bottorff
authors.affiliation: Medical Center, Sterling, IL, USA; University of Illinois School of Medicine-Peoria, Peoria, IL, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.lastname: The National Lipid Association's Safety Task Force
mesh_terms: D000070997:ATP Binding Cassette Transporter, Subfamily G, Member 2; D018528:ATP-Binding Cassette Transporters / Q000235:genetics; D000367:Age Factors; D000483:Alleles; D000998:Antiviral Agents / Q000737:chemistry / Q000493:pharmacokinetics; D019540:Area Under Curve; D044466:Asian People / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D003577:Cytochrome P-450 Enzyme System / Q000737:chemistry / Q000378:metabolism; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D027381:Liver-Specific Organic Anion Transporter 1; D009135:Muscular Diseases / Q000209:etiology; D063806:Myalgia / Q000209:etiology; D009363:Neoplasm Proteins / Q000235:genetics; D004366:Nonprescription Drugs / Q000737:chemistry / Q000493:pharmacokinetics; D027361:Organic Anion Transporters / Q000235:genetics; D012372:ROC Curve
chemical_list: C116614:ABCG2 protein, human; D000070997:ATP Binding Cassette Transporter, Subfamily G, Member 2; D018528:ATP-Binding Cassette Transporters; D000998:Antiviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D027381:Liver-Specific Organic Anion Transporter 1; D009363:Neoplasm Proteins; D004366:Nonprescription Drugs; D027361:Organic Anion Transporters; C503999:SLCO1B1 protein, human; D003577:Cytochrome P-450 Enzyme System
keywords: Cytochrome; Drug-drug interactions; Glucuronidation; Pharmacogenetics; Pharmacokinetics; Statins