gms | German Medical Science

Background: Statins are effective drugs for the primary and secondary prevention of cardiovascular disease events. As a class, statins are generally regarded as safe and serious adverse events, including muscle toxicity leading to rhabdomyolysis, are rare. Myopathy and rhabdomyolysis are rare with statin monotherapy at the approved dose ranges, but the risk increases with the use of higher doses and interacting drugs. Drug interactions may increase plasma levels of statins, with a consequent increased risk of toxic effects. Statins metabolized mainly by CYP450 system are more likely to produce muscle toxicity because of the risk of drug interactions with many drugs that inhibit CYP450, notably the CYP3A4 isoform.

In this context the clinician should remember that statins differ in metabolism and important drug-drug interactions are to consider.

For this reason a handout for clinicians could be helpful to prevent drug interactions by focusing on pharmacokinetic interactions caused by CYP3A4 system.

Materials and Methods: Analyses of drug interactions via database ADKA DokuPIK and creation of a handout to brief clinicians with respect to drug interactions with statins.

Results: 153 (18%) potential drug interactions with statins were documented in the database ADKA DokuPIK from 01.09.2010 to 30.07.2015 in the University Hospital of Jena. Macrolide antibiotics as well as azole antifungals were part of the most frequently used drugs that caused potential drug interactions with statins which are mainly metabolized via CYP450 3A4 system.

A handout was developed to prevent major statin-drug interactions by focusing on pharmacokinetic interactions caused by CYP3A4 system. The handout focuses on the mechanism and clinical relevance of potential interactions that affect statins. Many statins, such as simvastatin, lovastatin und atorvastatin, are metabolised predominantly by CYP3A4 system. Several drugs like macrolid antibiotics and azole antifungals, which are potent inhibitors of CYP3A4, mainly interact with lovastatin, simvastatin und atorvastatin. Contraindications must be considered. The handout provides an overview of the known drug interactions with statins.

Conclusion: The handout was implemented in the University hospital Jena to management statin interactions by focusing on pharmacokinetic interactions of statins caused by CYP3A4 system for the optimizing pharmacotherapy. To understand the mechanism of statin interactions can help to minimize drug interactions and statin-induced myopathy. Consideration of the differences between the statins is helping to provide a rational basis for their use in clinical practice.