Clinical Guidance for Managing Statin and Antimicrobial Drug-Drug Interactions.

Autor: Hylton Gravatt LA; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., PO Box 980533, Richmond, VA, 23298-0533, USA., Flurie RW; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., PO Box 980533, Richmond, VA, 23298-0533, USA., Lajthia E; Department of Clinical and Administrative Sciences, Howard University College of Pharmacy, Washington, DC, USA., Dixon DL; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., PO Box 980533, Richmond, VA, 23298-0533, USA. dldixon@vcu.edu.
Jazyk: angličtina
Zdroj: Current atherosclerosis reports [Curr Atheroscler Rep] 2017 Oct 09; Vol. 19 (11), pp. 46. Date of Electronic Publication: 2017 Oct 09.
DOI: 10.1007/s11883-017-0682-x
Abstrakt: Purpose of Review: This review discusses potential drug-drug interactions between statins and antimicrobials and provides clinician's guidance on how to manage these interactions.
Recent Findings: In addition to statin utilization increasing in recent years, there is greater emphasis on using moderate to high-intensity statin doses. Statin-related adverse effects are often dose-dependent; therefore, patients may be at increased risk. Antimicrobial use has also increased in recent years, and various efforts have been implemented to ensure appropriate use of antimicrobials. Commonly used antimicrobials, such as macrolide antibiotics and azole antifungals, interact significantly with the CYP3A4 enzyme pathway similarly to lovastatin, simvastatin, and atorvastatin. Consequently, the potential for significant drug-drug interactions is increasing. In 2012, the US Food and Drug Administration strengthened warning labels for statins and dose adjustments related to drug-drug interactions. As such, it is imperative that clinicians are comfortable identifying drug-drug interactions between statins and antimicrobials and making appropriate therapy modifications as clinically warranted. Statins and antimicrobials are frequently coprescribed, and the available pharmacokinetic data supports the potential for clinically significant drug-drug interactions. Macrolides and selected antifungals can significantly increase drug levels of select statins, particularly those metabolized by the CYP3A4 pathway. Contrarily, rifampin can significantly reduce drug levels of statins, limiting their efficacy. Future research efforts should identify interventions to improve clinician recognition of these drug-drug interactions and the prevention of unwarranted statin-related adverse effects.
Databáze: MEDLINE
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