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. 2014 Mar 31;3:168.
doi: 10.1186/2193-1801-3-168. eCollection 2014.

Potential Statin-Drug Interactions: Prevalence and Clinical Significance

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Free PMC article

Potential Statin-Drug Interactions: Prevalence and Clinical Significance

Maria Zhelyazkova-Savova et al. Springerplus. .
Free PMC article

Abstract

Background: Statins are cholesterol-lowering drugs widely used for cardiovascular prevention. Although safe when used alone, in combination with other drugs the likelihood of adverse drug reactions increases significantly. The exposure of the Bulgarian population to coprescriptions leading to potential statin-drug interactions is currently unknown.

Objective: The aim of this study was to investigate the incidence of coprescriptions involving statins and to compare the exposure of outpatients and inpatients to potential statin-drug interactions.

Setting: A cardiology clinic of the teaching University hospital in Varna, Bulgaria.

Method: This observational retrospective study examined the medical records of hospitalized patients prescribed a statin in combination with potentially interacting drugs. Patients who entered the hospital with a statin coprescription (considered outpatients) were compared with those coprescribed a statin at discharge from hospital (considered inpatients). Potentially interacting drugs included inhibitors and inducers of cytochrome P450 (CYP) enzymes and drugs of narrow safety margin (coumarin anticoagulants, digitalis).

Main outcome measure: The proportion of patients exposed to statin coprescriptions with potentially interacting drugs at hospital admission and discharge.

Secondary outcome measures: laboratory evidence supporting possible statin-drug interactions.

Results: Out of 1641 hospitalized patients examined, 572 were prescribed a statin, either at hospital admission or discharge. Simvastatin was most commonly prescribed and simvastatin-drug coprescription predominated, especially at discharge. The exposure to all potential statin-drug interactions was similar at hospital admission (26.1%) and discharge (24.4%), as was the exposure to statin combinations with CYP inhibitors, 6.4% and 4%, correspondingly. Overall, more coprescriptions were generated, than were eliminated by hospital physicians. Amiodarone was the CYP inhibitor most frequently coprescribed. Of all interacting drugs acenocoumarol was the most commonly found, the proportions of statin-acenocoumarol coprescriptions being roughly the same at hospital entry (11.5%) and discharge (12.4%). In 7 patients out of 69 exposed to the combination, INR was found to be higher than 3, indicating a risk of over-anticoagulation.

Conclusions: Potential statin-drug interactions are common. Although they do not differ between outpatient and inpatient settings, new hazardous coprescriptions are more frequently generated in hospital. Caution is required when acenocoumarol is coprescribed with statins, especially simvastatin.

Keywords: Acenocoumarol-statin interactions; CYP inhibitors; Hospital admission; Hospital discharge; INR; Statin-drug interactions.

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References

    1. Alsheikh-Ali AA, Karas RH. Adverse events with concomitant amiodarone and statin therapy. Prev Cardiol. 2005;8(2):95–97. doi: 10.1111/j.1520-037X.2005.4060.x. - DOI - PubMed
    1. Andreasen AH, Brøsen K, Damkier P. A comparative pharmacokinetic study in healthy volunteers of the effect of carbamazepine and oxcarbazepine on CYP3A4. Epilepsia. 2007;48(3):490–496. doi: 10.1111/j.1528-1167.2007.00924.x. - DOI - PubMed
    1. Andrus MR. Oral anticoagulant drug interactions with statins: case report of fluvastatin and review of the literature. Pharmacotherapy. 2004;24(2):285–290. doi: 10.1592/phco.24.2.285.33137. - DOI - PubMed
    1. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008;133(6 Suppl):160S–198S. doi: 10.1378/chest.08-0670. - DOI - PubMed
    1. Bakhai A, Rigney U, Hollis S, Emmas C. Co-administration of statins with cytochrome P450 3A4 inhibitors in a UK primary care population. Pharmacoepidemiol Drug Saf. 2012;21(5):485–493. doi: 10.1002/pds.2308. - DOI - PubMed

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