Drug-drug interactions between statins and antibiotics: A systematic review and meta-analysis of observational studies

Statins are frequently prescribed for the prevention of cardiovascular diseases. Certain antibiotics, especially macrolides, can raise the risk of side effects related to muscles and inhibit the metabolism of statins. Although results have been mixed, evidence from separate observational studies has pointed to a potential rise in statin-associated muscle toxicity when these drugs are used together. To evaluate whether the concurrent use of interacting antibiotics raises the risk of statin-associated muscle toxicity in comparison to statin therapy alone by conducting a systematic review and quantitative synthesis of observational data. A systematic literature search was conducted in various databases. Observational studies reporting risk estimates for statin-associated myopathy or rhabdomyolysis with concomitant antibiotic use were included. Data were extracted independently and pooled odds ratios (ORs) were calculated. Relative risks were treated as approximations of ORs due to the rarity of outcomes. Sensitivity analysis was performed using a leave-one-out approach. The meta-analysis included three observational studies that met the inclusion criteria. A markedly elevated risk of muscle toxicity was linked to the concurrent use of statins and interacting antibiotics. With a 95% confidence interval of 1.82-2.50, the pooled OR was 2.13. Sensitivity analysis showed that the results were robust since the pooled estimate did not change when individual studies were excluded. Concurrent use of interacting antibiotics with statins is associated with an increased risk of statin-associated muscle toxicity. Clinicians should exercise caution when prescribing such combinations, particularly in high-risk patients. Further large-scale studies are needed to better quantify risk across different statins and antibiotic classes.