Selected Macrolides/Selected HMG-CoA Reductase Inhibitors
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Severe. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
When these two medicines are taken together, your body may not process your cholesterol medicine properly.
What might happen:
The blood levels of your cholesterol medicine may increase and cause toxic effects.
What you should do about this interaction:
Let your healthcare professionals (e.g. doctor or pharmacist) know right away that you are taking these medicines together. Your doctor may instruct you to stop taking your cholesterol medicine while taking your antibiotic or adjust the dose of your cholesterol medicine.Tell your doctor right away if you experience muscle pain, tenderness, or weakness; unexplained tiredness; or discolored urine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Mevacor (lovastatin) US prescribing information. Merck & Co., Inc. February, 2012.
2.Anonymous. FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury. available at: http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm June 8, 2011.
3.Zocor (simvastatin) US prescribing information. Merck & Co., Inc. October, 2011.
4.Baycol (cerivastatin) US prescribing information. Bayer Corporation December, 2000.
5.Muck W, Ochmann K, Rohde G, Unger S, Kuhlmann J. Influence of erythromycin pre- and co-treatment on single-dose pharmacokinetics of the HMG-CoA reductase inhibitor cerivastatin. Eur J Clin Pharmacol 1998 Feb; 53(6):469-73.
6.Boberg M, Angerbauer R, Fey P, Kanhai WK, Karl W, Kern A, Ploschke J, Radtke M. Metabolism of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and of cytochrome P450 isozymes involved. Drug Metab Dispos 1997 Mar;25(3):321-31.
7.Kantola T, Kivisto KT, Neuvonen PJ. Erythromycin and verapamil considerably increase serum simvastatin and simvastatin acid concentrations. Clin Pharmacol Ther 1998 Aug;64(2):177-82.
8.Jacobson TA. Comparative pharmacokinetic interaction profiles of pravastatin, simvastatin, and atorvastatin when coadministered with cytochrome P450 inhibitors. Am J Cardiol 2004 Nov 1;94(9):1140-6.
9.Ayanian JZ, Fuchs CS, Stone RM. Lovastatin and rhabdomyolysis. Ann Intern Med 1988 Oct 15;109(8):682-3.
10.Spach DH, Bauwens JE, Clark CD, Burke WG. Rhabdomyolysis associated with lovastatin and erythromycin use. West J Med 1991 Feb;154(2):213-5.
11.Corpier CL, Jones PH, Suki WN, Lederer ED, Quinones MA, Schmidt SW, Young JB. Rhabdomyolysis and renal injury with lovastatin use. Report of two cases in cardiac transplant recipients. JAMA 1988 Jul 8;260(2):239-41.
12.Lilley LL, Guanci R. Drug interaction triggers weakness. Am J Nurs 1998 Apr;98(4):10.
13.Wong PW, Dillard TA, Kroenke K. Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy. South Med J 1998 Feb; 91(2):202-5.
14.Grunden JW, Fisher KA. Lovastatin-induced rhabdomyolysis possibly associated with clarithromycin and azithromycin. Ann Pharmacother 1997 Jul-Aug;31(7-8):859-63.
15.Huynh T, Cordato D, Yang F, Choy T, Johnstone K, Bagnall F, Hitchens N, Dunn R. HMG CoA reductase-inhibitor-related myopathy and the influence of drug interactions. Intern Med J 2002 Sep-Oct;32(9-10):486-90.
16.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.