Surviving AmericanSurviving
American Medicine

“Statins” are one of the most commonly used classes of drugs.  Millions of patients worldwide receive these to reduce cholesterol and reduce the risk of cardiac disease.  Examples of these drugs are Lipitor and Crestor.

Rarely, those medications can cause muscle problems, renal complications, or even death.  However, generally those medications are very safe and do not cause side effects.

However, it has recently been recognized that there may be serious complications with the use of certain antibiotics along with the statins.  Since the statins are metabolized by an enzyme called cytochrome P450 CYP3A4, antibiotics which reduce CYP3A4 enzyme activity can suddenly increase the blood concentrations of statins.  When that happens, side effects can be more common.

The antibiotics that have these side effects are clarithromycin and erythromycin (but not azithromycin).  The impact of using either of these antibiotics in combination with a statin was recently evaluated in an important study by A. Patel and co-authors (Annals of Internal Medicine volume

Beware drug interactions that could cause toxicity

158, page 869, 2013).  In a study of over 140,000 individuals who were on statins and who also used these antibiotics, they evaluated the increased risks of complications.  Muscle toxicity (rhabdomyolysis) was increased by 117%, acute kidney damage was increased by 78%.  Importantly, death from any cause was increased by 56%.

The implications of these findings are important.

• If you are taking statins be certain that you are cautious with your physician when antibiotics are needed.
• Remind the doctor that you are taking a statin.
• Be certain that if you need an erythromycin-related drug, that the physician uses azithromycin and not clarithromycin or erythromycin.
• If you are using statins and have problems with muscle pain or have a change in urinary patterns, be certain to call your physician right away to be evaluated for these unusual complications of cholesterol treatment.
• Be certain you take medications exactly as prescribed and review any change in your treatment with your physician.
• Whenever you are taking more than one medicine, check over your list of medicines (both prescriptions and also over the counter drugs or vitamins or herbs) with the pharmacist. The pharmacist is an important member of your health care team.

For more information on medications, see my new book “Surviving American Medicine.”