Statin Drug Interactions with Immunosuppressants

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Statin Drug Interactions With Immunosuppressants ✖ Statin-related myopathy is dose related, CYP3A4, P-gp and/or OAT1B1, altering occurring at rates of up to 25%. However, statin pharmacokinetics and increasing statin this risk can be increased tenfold when serum concentration. statins are administered with medications ✖ that inhibit metabolism. In solid organ transplant recipients, statins combined with cyclosporine increased AUC PROBLEM ✖ Statin combination with the by 3- to 20-fold compared to baseline, immunosuppressants cyclosporine and can lead to increased risk of myalgia, is subject to many pharmacokinetic myopathy or rhabdomyolysis. interactions. Statins are variably substrates ✖ for CYP450 enzyme metabolism, P-gp Rhabdomyolysis is a severe side effect efflux and OAT1B1 influx transporters. of statins, especially when combined with Immunosuppressants act as inhibitors of immunosuppressants like cyclosporine. Avoid combination of potentially interacting SOLUTION immunosuppressants and statins as outlined in the Treatment Table. TREATMENT TABLE: Cyclosporine Tacrolimus Everolimus Sirolimus Atorvastatin X ND 3 3 Fluvastatin Dose: 20 mg daily, not ND ND ND to exceed 20 mg bid Lovastatin X ND 3 ND Pitavastatin X ND 3 ND Pravastatin Max Dose: 20 mg daily ND ND ND Rosuvastatin Max Dose: 5 mg daily ND ND ND Simvastatin X ND 3 ND ©2019 American College of Cardiology W19001 ©2019 American College of Cardiology X Do not use 3 Ok to use per package insert ND: No data in package insert regarding combining with statin. Use presumed to be okay PREVENT POTENTIAL ERRORS ✔ Educate providers on interactions with statins ✔ Monitor for other drug-drug interactions that and immunosuppressants. may further increase exposure to statins. ✔ Closely monitor patients on combination ✔ Functional hard-stop drug alerts during order ! therapy for muscle-related symptoms. entry in electronic medical record. To download the infographic and see citations visit ACC.org/Infographics.

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What Precautions Should We Use with Statins for Women of Childbearing
CLINICAL INQUIRIES What precautions should we use with statins for women of childbearing age? Chaitany Patel, MD, Lisa Edgerton, PharmD New Hanover Regional Medical Center, Wilmington, North Carolina Donna Flake, MSLS, MSAS Coastal Area Health Education Center, Wilmington, NC EVIDENCE- BASED ANSWER Statins are contraindicated for women who are on its low tissue-penetration properties. pregnant or breastfeeding. Data evaluating statin Cholesterol-lowering with simvastatin 40 mg/d did use for women of childbearing age is limited; how- not disrupt menstrual cycles or effect luteal phase ever, they may be used cautiously with adequate duration (strength of recommendation: C). contraception. Pravastatin may be preferred based CLINICAL COMMENTARY Use statins only as a last resort Before reading this review, I had not been for women of childbearing age ® Dowdenaware Health of the serious Media effects of statin medications I try to follow the USPSTF recommendations and on the developing fetus. In conversations with not screen women aged <45 years without coro- my colleagues, I found that the adverse effects nary artery disease riskCopyright factors for Fhyperlipidemia.or personalof usestatins onlyduring pregnancy are not readily When a woman of any age needs treatment, my known. Such information needs to be more first-line therapy is lifestyle modification. Given the widely disseminated. risks of statin drugs to the developing fetus, Ariel Smits, MD women with childbearing potential should give Department of Family Medicine, Oregon Health & Science fully informed consent and be offered reliable University, Portland contraception before stating statin therapy. I Evidence summary anal, cardiac, tracheal, esophageal, renal, Hydroxymethyl glutaryl coenzyme A and limb deficiency (VACTERL associa- (HMG CoA) reductase inhibitors, com- tion), intrauterine growth retardation monly called statins, have been on the (IUGR), and demise in fetuses exposed market since the late 1980s.
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Effect of Statins and ACE Inhibitors Alone and in Combination on Clinical Outcome in Patients with Coronary Heart Disease
Journal of Human Hypertension (2004) 18, 781–788 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Effect of statins and ACE inhibitors alone and in combination on clinical outcome in patients with coronary heart disease VG Athyros1, DP Mikhailidis3, AA Papageorgiou2, VI Bouloukos1, AN Pehlivanidis1, AN Symeonidis4 and M Elisaf5, for the GREACE Study Collaborative Group 1Atherosclerosis Unit, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; 2Department of Clinical Biochemistry, Royal Free Hospital, Royal Free and University College Medical School, Pond Street, London, UK; 32nd Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; 4Greek Society of General Practitioners, Thessaloniki, Greece; 5Department of Internal Medicine, Medical School, University of Ioannina, Greece We assessed the ‘synergy’ of statins and angiotensin- point in group A was 31%, (95% CI À48 to À6%, P ¼ 0.01) converting enzyme inhibitors (ACEI) in reducing vascu- in comparison to group B, 59% (95% CI À72 to À48%, lar events in patients with coronary heart disease (CHD). Po0.0001) to group C and 63% (95% CI À74 to À51%, The GREek Atorvastatin and CHD Evaluation (GREACE) Po0.0001) to group D. There was no significant Study, suggested that aggressive reduction of low difference in RRR between groups C and D (9%, CI density lipoprotein cholesterol to 2.59 mmol/l À27–10%, P ¼ 0.1). Other factors (eg the blood pressure) (o100 mg/dl) significantly reduces morbidity and mor- that can influence clinical outcome did not differ tality in CHD patients, in comparison to undertreated significantly between the four treatment groups.
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Get the Facts: What You Need to Know About Statins
Get the Facts: What You Need to Know About Statins We hear a lot about lowering our cholesterol by eating a low-fat diet and getting regular exercise. But for some people, making healthy changes isn’t enough. That’s when statins come in. Statins are medicines that reduce the risk of heart disease and stroke, two of the leading causes of death in the United States. These medicines keep the liver from making cholesterol and help it get rid of cholesterol in the blood. Statins may help if you have high cholesterol, heart disease or are at high risk for heart disease or stroke. Things that can put you at high risk include being a current or former smoker, stress, having diabetes and/or high blood pressure, having a family history of heart disease or stroke, or being overweight. This means you do not have to have high cholesterol to benefit from taking statins. What Are Some Examples of Statins? Below is a list of statins you may have heard of and where you can find them on the SCAN Health Plan® Formulary (Note: The SCAN Formulary and the Formulary tier are subject to change, especially from year to year.): Statin Formulary Status Brand Name Generic Name Lipitor® Atorvastatin Tier 1 Mevacor® Lovastatin Tier 1 Pravachol® Pravastatin Tier 1 Zocor® Simvastatin Tier 1 Crestor® Rosuvastatin Tier 2 Lescol® Fluvastatin Not available Livalo® Pitavastatin Not available Statins can also be combined with other cholesterol-lowering and blood pressure drugs into one pill but may have higher copays. If you have questions about these combination pills and their copays, please talk to your pharmacist.
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FDA Requests Removal of Strongest Warning Against Using Cholesterol
FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy; still advises most pregnant patients should stop taking statins Breastfeeding not recommended in patients who require statins 7-20-2021 FDA Drug Safety Communication What safety information is FDA announcing? The U.S. Food and Drug Administration (FDA) is requesting removal of its strongest warning against using cholesterol-lowering statin medicines in pregnant patients. Despite the change, most patients should stop statins once they learn they are pregnant. We have conducted a comprehensive review of all available data and are requesting that statin manufacturers make this change to the prescribing information as part of FDA’s ongoing effort to update the pregnancy and breastfeeding information for all prescription medicines. Patients should not breastfeed when taking a statin because the medicine may pass into breast milk and pose a risk to the baby. Many can stop statins temporarily until breastfeeding ends. However, patients requiring ongoing statin treatment should not breastfeed and instead use infant formula or other alternatives. What is FDA doing? We are requesting revisions to the information about use in pregnancy in the prescribing information of the entire class of statin medicines. These changes include removing the contraindication against using these medicines in all pregnant patients. A contraindication is FDA’s strongest warning and is only added when a medicine should not be used because the risk clearly outweighs any possible benefit. Because the benefits of statins may include prevention of serious or potentially fatal events in a small group of very high-risk pregnant patients, contraindicating these drugs in all pregnant women is not appropriate.
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Analgesic Drug Use Associated with Statin Prescription – a Cross- Sectional Study in Primary Care Settings D
16 Current Drug Safety, 2012, 7, 16-20 Analgesic Drug Use Associated with Statin Prescription – A Cross- Sectional Study in Primary Care Settings D. Moßhammer*,1, J. Schwarz1, S. Meznaric1, R. Muche2, G. Lorenz1 and K. Mörike3 1Division of General Practice, University Hospital Tübingen, Germany 2Institute of Biometrics, University of Ulm, Germany 3University Hospital Tübingen, Institute of Experimental and Clinical Pharmacology and Toxicology, Department of Clinical Pharmacology, Germany Abstract: Background: To investigate whether features of muscular complaints (MC) differ between receivers of a statin prescription and non-receivers. To analyze the relationship between analgesics prescription, statin prescription and/or musculoskeletal disorders. Methods: Cross-sectional study. Consecutive patients in offices of family practitioners were interviewed using a standardized questionnaire. Target variables: Rates of features of MC in patients with or without a statin prescription and rates of analgesic drug prescription in patients with or without statin prescription and/or musculoskeletal disorders. Odds ratios (adjusted for age, sex, and socio-economic status) were calculated using logistic regression analysis. Results: 1135 patients in 26 general practitioners’ offices were asked to participate, and 1031 patients agreed. Features of MC did not differ between the two groups of patients. Analgesic prescription was found to be associated with statin prescription in patients without musculoskeletal disorders (OR 2.2, CI 1.1-4.7 without statin, OR 2.5, CI 0.9-6.9 with statin) and particularly in those with musculoskeletal disorders (OR 5.2, CI 2.9-9.3 without statin, OR 9.3, CI 4.5-19.1 with statin). Conclusions: Analgesic prescriptions are probably positively associated with statin prescription.
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bioRxiv preprint doi: https://doi.org/10.1101/349332; this version posted June 17, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Abstract: 250 words Main text: 3,440 words Figures: 3 Tables: 2 Supplementary material: 2 Tables Statin treatment and the risk of depression Ole Köhler-Forsberg MD1,2, Christiane Gasse PhD2,3,4, Liselotte Petersen PhD2,3,4, Andrew A. Nierenberg MD5,6, Ole Mors MD PhD1,2, Søren Dinesen Østergaard MD PhD2,7,8 1 Psychosis Research Unit, Aarhus University Hospital - Risskov, Risskov, Denmark 2 The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark 3 National Centre for Register-based Research, Aarhus University, Aarhus, Denmark 4 Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark 5 Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA 6 Harvard Medical School, Boston, MA, USA 7 Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark 8 Department of Affective Disorders, Aarhus University, Aarhus, Denmark Corresponding author: Ole Köhler-Forsberg, MD Psychosis Research Unit Aarhus University Hospital - Risskov Skovagervej 2 DK-8240 Risskov Mail: [email protected] Phone: +45 2342 0661 Fax: +45 7847 1609 1 bioRxiv preprint doi: https://doi.org/10.1101/349332; this version posted June 17, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. ABSTRACT The effect of statin treatment on the risk of developing depression remains unclear.
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