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Interaction potential between clarithromycin and individual statins-A systematic review.

Mette Marie Hougaard Christensen1,2, Maija Bruun Haastrup1,2, Thomas Øhlenschlaeger1

  • 1Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.

Basic & Clinical Pharmacology & Toxicology
|October 20, 2019
PubMed
Summary

Clarithromycin use can significantly increase the risk of statin-related adverse events, particularly rhabdomyolysis, when co-administered with certain statins. Healthcare providers should carefully manage these drug combinations to ensure patient safety.

Keywords:
MiniReviewcase reportclarithromycindrug-drug interactionstatins

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Area of Science:

  • Pharmacology
  • Drug Interactions
  • Clinical Pharmacy

Background:

  • Clarithromycin and statins are widely prescribed, leading to frequent co-utilization.
  • Drug-drug interactions (DDIs) between clarithromycin and statins can elevate statin exposure and increase the risk of adverse events.

Purpose of the Study:

  • To review the evidence on DDIs between clarithromycin and marketed statins.
  • To provide management strategies for co-administering clarithromycin with statins.

Main Methods:

  • Systematic literature review following PRISMA guidelines.
  • Searched PubMed and EMBASE databases for English language studies up to March 2019.
  • Included case reports, observational, pharmacokinetic, and in vitro studies.

Main Results:

  • Clarithromycin significantly increases exposure to simvastatin and lovastatin (>5-fold AUC).
  • Moderate increases in exposure for atorvastatin and pitavastatin (2-4 fold AUC), slight increase for pravastatin (≈2-fold AUC).
  • 16 cases of myopathy/rhabdomyolysis linked to clarithromycin with CYP3A4-metabolized statins; doubled risk of hospitalization with these combinations.

Conclusions:

  • Avoid co-administration of clarithromycin with simvastatin, lovastatin, or atorvastatin.
  • Consider withholding or dose-reducing pitavastatin; use pravastatin cautiously (≤40 mg/day).
  • Continue fluvastatin or rosuvastatin with caution; these statins have lower interaction risk.