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Author: Admin | 2025-04-28
Statins are one of the most commonly prescribed medications to help manage hyperlipidemia and reduce the risk of cardiovascular events. However, statins are notorious for their drug interactions which can pose a significant risk to patients if not taken into consideration. Working in a retail pharmacy, I frequently encounter cases involving statin drug interactions that require intervention by either contacting the provider and/or educating patients on monitoring parameters. In this article, I want to focus on the most common statin drug interactions you’ll see in the ambulatory pharmacy setting.Grapefruit JuiceProbably the most well-known drug interaction with statins. Grapefruit (or grapefruit juice) is a strong CYP3A4 inhibitor, the major enzyme responsible for the breakdown of atorvastatin, simvastatin, and lovastatin. The inhibition of this enzyme can lead to increased plasma statin concentrations, increasing the patient’s risk for developing adverse side effects such as myalgia and rhabdomyolysis. Grapefruit is best avoided in patients taking these three statins. So if a patient is a big fan of grapefruit and really does not want to give it up, it’s best to change to an alternative statin such as rosuvastatin or pravastatin to avoid this drug interaction. If you are looking for more information about grapefruit interactions, you must listen to this podcast episode.Azole AntifungalsAzole antifungals are also a class of medications known for their statin drug interactions. Depending on the specific azole, there are varying degrees of inhibition of CYP2C19, CYP2C9, and most importantly CYP3A4. Like with grapefruit, this enzyme inhibition increases statin concentrations in the body, leading to an increased risk of adverse effects. While short courses of azole antifungals taken in combination with statins are not likely to cause major issues, long-term use could pose a greater risk to the patient.GemfibrozilStatins do a good job of reducing total cholesterol, but some patients require additional therapy to help further lower cholesterol and triglycerides. Fibrates are very effective in lowering triglycerides while also providing some total cholesterol lowering effects. However, depending on the specific fibrate used, there are varying degrees of interactions with statins. While fenofibrate is generally considered safer in combination with statins, gemfibrozil should be avoided. Gemfibrozil is an inhibitor of OATP1B1, a transporter that statins use to enter the liver. When this transporter is inhibited, plasma statin concentrations increase, and the patient’s risk for adverse effects like myalgia and rhabdomyolysis also increase.PaxlovidPaxlovid is a newer drug on the market used for the treatment of COVID-19 that has gained a lot of popularity. Paxlovid is a combination medication composed of two drugs, nirmatrelvir and ritonavir. Ritonavir is used in this formulation specifically for its strong CYP3A4 inhibitory properties to help enhance the effects of nirmatrelvir. Due to this strong inhibition, the majority of
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