Guidance issued on drug-drug interactions for statins, heart meds
A new statement from the American Heart Association recommends that in patients taking amlodipine combined with simvastatin or lovastatin, the dosage of either statin should not exceed 20 mg/d, and for patients in whom statin-fibrate therapy is indicated, fenofibrate or fenofibric acid is preferred because of a lower rate of drug-drug interactions.
The American Heart Association released a scientific statement last week offering guidance on managing clinically significant drug-drug interactions for statins and cardiovascular medications.
The statement provides an overview of drug-drug interactions and the pharmacological differences among various statins, describes how they relate to certain medications used to treat patients who have cardiovascular disease, and offers recommendations on clinical management. Recommendations were based on data from clinical trials, case reports, prescribing information, and pharmacokinetic studies.
The recommendations cover drug-drug interactions between statins and each of the following: fibrates, calcium-channel blockers, antiarrhythmic agents, ranolazine, warfarin, ticagrelor, conivaptan, vasopressin-receptor antagonists, immunosuppressive agents, colchicine, and heart failure medications. Tables are provided summarizing the evidence for and magnitude of drug-drug interactions with statins as well as recommendations for management.
For example, the statement recommends that in patients taking amlodipine combined with simvastatin or lovastatin, the dosage of either statin should not exceed 20 mg/d, and for patients in whom statin-fibrate therapy is indicated, fenofibrate or fenofibric acid is preferred because of a lower rate of drug-drug interactions. The writing committee noted that it is often impossible to avoid drug interactions with statins in cardiovascular patients, making appropriate clinical management essential, and stressed that clinicians must have thorough knowledge of the pharmacokinetics of both statins and medications often prescribed with them in combination.
In addition, the committee wrote, “A review of all medications that statin-treated patients are taking should be done at each clinical encounter and during transitions of care within a health system so that [drug-drug interactions] can be identified early, evaluated, and managed appropriately by implementing doses adjustments, changing to a safer statin medication, or discontinuing when needed.”
The statement, which was published online Oct. 17 by Circulation, is available free of charge online.