Original articleConcomitant use of statins and CYP3A4 inhibitors in administrative claims and electronic medical records databases
Section snippets
Data sources
Exposure to prescription medications was approximated using prescriptions dispensed from the PharMetrics Integrated Patient-Centric database and prescriptions written from the GEMS database. Eligible patients were aged ≥18 years and exposed to ATV, FLV, LOV, PRV, RSV, SMV, or SMV/EZE during the study period.
The PharMetrics Patient-Centric database includes longitudinal, integrated patient-level medical and pharmacy claims from 47 primarily private, as well as public (Medicare supplemental and
Results
Known CYP3A4 inhibitors, including those listed in the precautions sections of United States product labels, and potential CYP3A4 inhibitors identified,28, 29 are shown in Figure 1.
Discussion
Adverse drug reactions account for 3–7% of medical hospital admissions,30 and are the sixth leading cause of death, contributing to substantial morbidity, particularly in the elderly.31, 32 A propensity for physicians to repeatedly prescribe potentially interacting drug combinations has been shown previously. For example, records from computerized drug prescription screening systems and general practice databases have been used to demonstrate persistent and repeated co-prescribing of
Financial disclosures
Drs. Ming, Gandhi, Marotti, Miles, and Ke are employees of AstraZeneca. Dr. Davidson is an investigator for the AstraZeneca METEOR trial and is a consultant for AstraZeneca, Merck/Schering-Plough, Pfizer, and Takeda Pharmaceuticals. Dr. McKenney has provided consultancy for Abbott Laboratories, Agerion, AstraZeneca, Merck & Co, and Daiichi Sankyo.
Acknowledgment
The authors acknowledge editorial support from Carl Felton of Prime Medica, which was funded by AstraZeneca. Pia Pollack of AstraZeneca provided scientific input and reviewed the manuscript. Opinions expressed remain those of the named authors.
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Drug–drug interactions involving CYP3A4 and p-glycoprotein in hospitalized elderly patients
2019, European Journal of Internal MedicineCitation Excerpt :Conversely, our data are partially comparable to those reported in studies conducted selectively on CYP3A4, analyzing co-prescription of statins with CYP3A4 inhibitors. These studies showed that approximately 6–9% of patients exposed to a statins metabolized from CYP3A4 had a concomitant inhibitor [44] while a study conducted in UK primary care population showed an inappropriate co-prescription in 11% of patients [45]. These data, however, were extracted from the general population and not applicable to hospitalized older people.
Concomitant use of statins and macrolide antibiotics and risk of serious renal events: A nationwide cohort study
2018, International Journal of CardiologyCitation Excerpt :Thus, taken together, this could suggest that if an increased risk of renal failure truly exists with concomitant use of statins and macrolides metabolized by and inhibiting CYP3A4, it is possible that the potential for such statin-macrolide drug-drug interaction is less pronounced in younger populations with a relatively lower baseline risk of renal failure. The prevalence of concurrent medication with statins and various inhibitors of CYP3A4 (also including other drugs than macrolide antibiotics) has been reported from 2.8% up to around 30% in various populations [23–26] indicating that such combination of drugs is common. Previous in vivo evidence reports increases of the area under the plasma concentration drug curve of the various CYP3A4-metabolized statins (or their active metabolites) of varying magnitude (from 33% up to a 14-fold increase) with co-administration of erythromycin, clarithromycin or roxithromycin [27–30].
Prevalence of potential drug interactions in Thai patients receiving simvastatin: The causality assessment of musculoskeletal adverse events induced by statin interaction
2017, Saudi Pharmaceutical JournalCitation Excerpt :The prevalence of potential simvastatin-drug interactions found in Thai patients is consistent with that of previous studies from other countries and is in the range of 6–13% (Ratz Bravo et al., 2005; Ming et al., 2008; Tirkkonen et al., 2008; Devold et al., 2009; Bakhai et al., 2012). However, the most common precipitant drugs for potential simvastatin-drug interactions were gemfibrozil, colchicine and amlodipine, while previous studies showed that verapamil, diltiazem and macrolide antibiotics were most frequently co-prescribed with statins (Ratz Bravo et al., 2005; Ming et al., 2008; Tirkkonen et al., 2008; Devold et al., 2009; Bakhai et al., 2012). These inconsistent results could be due to differences in research settings, criteria for selecting potential statin-drug interactions, availability of medication in hospital formularies, the reimbursement policy and the clinical practice guidelines during the study period.
Importance of dyslipidaemia in cardiovascular disease: A point of view
2015, Clinica e Investigacion en Arteriosclerosis