Statin Toxicity From Macrolide Antibiotic Coprescription

@article{Patel2013StatinTF,
  title={Statin Toxicity From Macrolide Antibiotic Coprescription},
  author={Amit M. Patel and Salimah Z. Shariff and David G Bailey and David N Juurlink and Sonja Gandhi and Muhammad M Mamdani and Tara Gomes and Jamie L Fleet and Y. Joseph Hwang and Amit X. Garg},
  journal={Annals of Internal Medicine},
  year={2013},
  volume={158},
  pages={869 - 876}
}
BACKGROUND Clarithromycin and erythromycin, but not azithromycin, inhibit cytochrome P450 isoenzyme 3A4 (CYP3A4), and inhibition increases blood concentrations of statins that are metabolized by CYP3A4. OBJECTIVE To measure the frequency of statin toxicity after coprescription of a statin with clarithromycin or erythromycin. DESIGN Population-based cohort study. SETTING Ontario, Canada, from 2003 to 2010. PATIENTS Continuous statin users older than 65 years who were prescribed… 

Comparing two types of macrolide antibiotics for the purpose of assessing population-based drug interactions

Clarithromycin can be used to assess drug interactions in population-based studies with azithromyzin serving as a control group, however, any differences in mortality observed between the two antibiotic groups in the setting of other drug use may be partially attributable to factors beyond the inhibition of drug metabolising enzymes and transporters.

Interaction Potential between Clarithromycin and Individual Statins - a Systematic Review.

Concurrent use of clarithromycin and CYP3A4-metabolized statins to be associated with a doubled risk of hospitalisation with rhabdomyolysis or other statin-related adverse events as compared with azithromyquin-statin co-administration.

Co-Medication of Statins with Contraindicated Drugs

The proportion of co-medication of statins with contraindicated drugs was relatively lower than that of previous studies; however, the co-Medication occurring by different medical institutions was not managed appropriately.

Risk of adverse events among older adults following co-prescription of clarithromycin and statins not metabolized by cytochrome P450 3A4

Among older adults taking a statin not metabolized by CYP3A4, co-prescription of clarithromycin versus azithromyzin was associated with a modest but statistically significant increase in the 30-day absolute risk of adverse outcomes.

Risks of Adverse Events Following Coprescription of Statins and Calcium Channel Blockers

Patients who received CYP3A4-metabolized statins had significantly higher risk of acute kidney injury, hyperkalemia, acute myocardial infarction, and acute ischemic stroke than those who received non-CYP3A 4-metabolic statins.

Clinical manifestation of macrolide antibiotic toxicity in CKD and dialysis patients

Two cases of end-stage renal disease (ESRD) patients who developed hallucinations such as vivid images of worms after taking clarithromycin were reported, similar to previous case reports of clarityromycin neurotoxicity.

Rhabdomyolysis Associations with Antibiotics: A Pharmacovigilance Study of the FDA Adverse Event Reporting System (FAERS)

This study confirms prior evidence for rhabdomyolysis associations with daptomycin, macrolides, trimethoprim-sulfamethoxazole, linezolid, fluoroquinolones, and cefdinir, and identifies previously unknown rhabDomyolytic associations with meropenem, cefditoren,cefaclor, and piperacillin-tazobactam.

Statin-Related Myotoxicity: A Comprehensive Review of Pharmacokinetic, Pharmacogenomic and Muscle Components

Further research is required, including stringent phenotyping of mild SRM through N-of-1 trials coupled to systems pharmacology omics- approaches to identify novel risk factors and provide mechanistic insight.

The clinical significance of statins-macrolides interaction: comprehensive review of in vivo studies, case reports, and population studies

Understanding the different characteristics of each statin and macrolide, as well as key patients’ risk factors, will enable health care providers to utilize both groups effectively without compromising patient safety.
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