Can statins plus erythromycin easily become a "mixed poison"? Listen to what the pharmacist says

Statins are commonly used to prevent cardiovascular and cerebrovascular diseases. They can prevent or even reverse atherosclerosis and are widely used. However, many people told Huazi that they are worried about adverse reactions when using statins for a long time.

Hua Zi said that overall, statins are very safe, and there is no big problem as long as they are not used excessively. However, there is one issue that needs attention, that is, when statins are used in combination with other drugs, drug interactions may occur, causing adverse reactions, especially macrolide antibiotics represented by erythromycin.

1. Statins that are prone to drug interactions Relatively speaking, simvastatin, lovastatin, and atorvastatin are more likely to interact with other drugs because these three statins need to be metabolized by the liver enzyme CYP3A4, and CYP3A4 is a "crowded road" through which many drug metabolisms need to pass.

Therefore, when taking other drugs that affect the CYP3A4 enzyme, it is easy to interfere with the metabolism of statins, thereby leading to accumulation of statins, and easily causing serious adverse reactions such as liver damage and rhabdomyolysis.

Fluvastatin, pravastatin, rosuvastatin, and pitavastatin are not metabolized by the CYP3A4 enzyme and are much less affected.

2. Effects of macrolides on statins Among the drugs that affect CYP3A4, macrolide antibiotics are the most common, including erythromycin, clarithromycin, roxithromycin, azithromycin, etc. Macrolide antibiotics have a strong inhibitory effect on the CYP3A4 enzyme and will seriously affect the metabolism of statins.

Macrolide antibiotics are broad-spectrum antibiotics that are widely used and many people use them without authorization. Problems are likely to occur if the above three statins that are metabolized by the CYP3A4 enzyme are taken at the same time.

In addition to macrolide antibiotics, grapefruit and conazole antifungal drugs (such as itraconazole, fluconazole, etc.) also have inhibitory effects on the CYP3A4 enzyme and should be avoided when taken at the same time as statins.

3. What to do when encountering drug interactions Simvastatin, lovastatin and atorvastatin should not be used in combination with macrolide drugs that affect the CYP3A4 enzyme. When combined use is necessary, it is recommended to switch to other statins with less impact under the guidance of a doctor.

It should be noted that other statins only have a smaller effect, not no effect. When combined with other drugs, it is necessary to reduce the dosage and monitor the levels of liver transaminases (ALT, AST) and creatine kinase (CK).

If an abnormal increase in indicators is found, or if symptoms of adverse reactions occur, statins can be temporarily discontinued. After the infection is controlled, macrolides can be discontinued and then resumed.

4. Adverse reactions are only rare events. The probability of adverse reactions is not high during the use of statins. Even if used in combination with macrolide drugs that affect the activity of CYP3A4 enzymes, the probability of causing adverse reactions is only "increased possibility".

Most patients can tolerate the accumulation of statins without problems. However, factors such as advanced age, renal insufficiency, diabetes, cardiovascular and cerebrovascular diseases can more easily cause accumulation of statin myotoxicity and hepatotoxicity, leading to serious adverse reactions.

For safety reasons, when taking statins such as simvastatin, lovastatin, and atorvastatin, you should avoid using them in combination with macrolide antibiotics such as erythromycin, clarithromycin, roxithromycin, and azithromycin. People who take other statins should use them with caution under the guidance of a doctor.

In summary, when statins are used in combination with macrolide antibiotics represented by erythromycin, drug interactions may occur, increasing toxicity to the human body, so attention should be paid. The safe way to use medication is to explain your medication situation in detail to the doctor and use the medication under the doctor's guidance. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.