A Statin Interaction Reference
(Something I first read 5 years ago)
Your EMR, Epocrates, Lexicomp and your local pharmacy may give you four different opinions on which drugs interact (and how much) with each other.
Statins’ interaction with Paxlovid became a concern during the pandemic. But it’s far from the only one and we don’t always think of all of them.
Here are some quotes from a seven year old article I ran into five years ago when I needed to research the interactions between statins and colchicine. (It turns out rosuvastatin has only one pathway for interaction with colchicine while simvastatin and atorvastatin have two, making rosuvastatin “reasonable”.)
“Given the important role of statins in patients with atherosclerotic CVD (ASCVD) and those at high ASCVD risk, combination therapy with statins and other CV medications is highly likely, and potentially significant DDIs must be considered in patients treated with statins.”
“Coadministration of colchicine and rosuvastatin, fluvastatin, lovastatin, pitavastatin, and pravastatin is reasonable when clinically indicated. Dose reductions may be considered for atorvastatin, simvastatin, and lovastatin, given the potential for interactions mediated by both CYP3A4 and permeability glycoprotein (P-gp) pathways.”
“When statin-fibrate combination therapy is indicated, fenofibrate or fenofibric acid is preferred because of a reduced incidence of DDIs compared with the gemfibrozil-statin combination. There are circumstances in which gemfibrozil may be the only available fibrate, cost may be a consideration, or fenofibrate may not be tolerated. Under any circumstance, the use of gemfibrozil should be avoided in combination with lovastatin, pravastatin, and simvastatin.”
“Atorvastatin is the only statin that appears to be associated with a potential DDI when used in combination with digoxin. On the basis of the available data, patients on higher doses of atorvastatin may be at increased risk of digoxin toxicity, and closer monitoring for digoxin toxicity is recommended.”
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/10/20/21/53/recommendations-for-management-of-clinically-significant-drug
And in 2011 I learned an important lesson about their differing interactions with warfarin:
https://acountrydoctorwrites.blog/2011/01/13/a-deadly-interaction/