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[Interaction risk with statin switch].

Espen Molden1, Tone Westergren

  • 1Farmasøytisk institutt, Universitetet i Oslo.

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|February 17, 2007
PubMed
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Switching to simvastatin may increase risks of adverse drug reactions due to interactions with warfarin and CYP3A4 inhibitors. Atorvastatin has a lower interaction potential compared to simvastatin.

Area of Science:

  • Pharmacology
  • Drug Interactions
  • Clinical Pharmacy

Background:

  • Two adverse drug reaction reports after switching from atorvastatin to simvastatin prompted this investigation.
  • Suspected causes included simvastatin interactions with warfarin and diltiazem (a CYP3A4 inhibitor), leading to intracranial hemorrhage and myopathy.

Purpose of the Study:

  • To evaluate potential differences in the interaction profiles of atorvastatin and simvastatin.
  • To assess the clinical significance of these drug interactions.

Main Methods:

  • Searches of PubMed and ISI Web of Knowledge databases for relevant interaction studies.
  • Examination of interaction databases and product monographs.

Main Results:

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  • Warfarin-simvastatin interactions showed increased INR and reduced warfarin dose (10-30%).
  • Warfarin-atorvastatin interaction showed no significant prothrombin time changes.
  • Simvastatin exhibited significantly greater increases in plasma concentration with CYP3A4 inhibitors compared to atorvastatin.

    • Conclusions:

    • Atorvastatin and simvastatin have different interaction potentials with warfarin and CYP3A4 inhibitors.
    • Clinicians should consider interaction risks when prescribing or switching to simvastatin.