Statins are commonly used drugs to prevent cardiovascular and cerebrovascular diseases, which can prevent or even reverse atherosclerosis and are widely used. But many people told Huazi that they were worried about adverse reactions when they used statins for a long time.
Huazi said that overall, the safety of statins is very high, as long as the use of statins is not excessive, there is no major problem. However, there is a problem that needs to be noted, that is, when statins are combined with other drugs, there may be drug interactions and adverse reactions, especially macrolide antibiotics represented by erythromycin.
First, statins that are prone to drug interactions
Relatively speaking, simvastatin, lovastatin, and atorvastatin, these three statins are more likely to interact with other drugs. Because these 3 statins need to be metabolized by the liver drug enzyme CYP3A4, and CYP3A4 is a "crowded road", many drug metabolism needs to pass through this path.
Therefore, when taking other drugs that have an impact on the CYP3A4 enzyme, it is easy to interfere with the metabolism of statins, resulting in the accumulation of statins, prone to liver damage, rhabdomyolysis and other serious adverse reactions.
Fluvastatin, pravastatin, rosuvastatin, and pitvastatin are not metabolized by the CYP3A4 enzyme and are much less affected.
Second, the effect of macrolides on statins
Among the drugs that have an effect on CYP3A4, macrolide antibiotics are the most common, mainly erythromycin, clarithromycin, roxithromycin, azithromycin and so on. Macrolide antibiotics have a strong inhibitory effect on CYP3A4 enzymes and will seriously affect the metabolism of statins.
Macrolide antibiotics are broad-spectrum antibiotics, the application is very common, and many people will use it without authorization, if you take the above 3 statins metabolized by the CYP3A4 enzyme at the same time, it is prone to problems.
In addition to macrolide antibiotics, grapefruit (grapefruit) and conazole antifungal drugs (such as itraconazole, fluconazole, etc.) also have inhibitory effects on CYP3A4 enzymes, and it is also necessary to avoid taking them at the same time as statins.
Third, what to do when encountering drug interactions
Simvastatin, lovastatin, and atorvastatin should be avoided in combination with macrolides that affect the CYP3A4 enzyme. In cases where a combination of drugs is necessary, it is recommended to switch to other statins with lesser effect under the guidance of a doctor.
It is important to note that other statins have only less effect, not no effect. In combination, tapering is required and hepatic transaminases (ALT, AST) and creatine kinase (CK) levels are monitored.
If abnormally elevated markers are found, or symptoms of adverse reactions occur, statins can be discontinued temporarily, and after infection control, macrolides can be discontinued before resuming.
Fourth, adverse reactions are only small probability events
During the use of statins, the probability of adverse reactions is not high. Even when combined with macrolides that affect the activity of the CYP3A4 enzyme, the probability of adverse reactions is only "increased" in probability.
Most patients can tolerate the accumulation effect of statins without problems. However, when there are factors such as advanced age, renal insufficiency, diabetes, cardiovascular and cerebrovascular diseases, it is more likely to cause the accumulation of statin myotoxicity and liver toxicity, causing serious adverse reactions.
For safety reasons, when taking statin drugs such as simvastatin, lovastatin, and atorvastatin, it should be avoided in combination with macrolide antibiotics such as erythromycin, clarithromycin, roxithromycin, and azithromycin. Those taking other statins should be cautiously combined under the guidance of a doctor.
To sum up, when statins are combined with macrolide antibiotics represented by erythromycin, drug interactions may occur and increase toxicity to the human body, and attention should be paid to. A safe way to use medication is to explain your medication to your doctor in detail and use the medication under the guidance of a doctor. If you have any questions about medication, consult your doctor or pharmacist. I am a pharmacist Huazi, welcome to follow me and share more health knowledge.