Acute Myopathy in a Patient with Concomitant Use of Pravastatin and Colchicine

Alaylı, Gamze; Cengiz, K.; Cantürk, Ferhan; Durmuş, Dilek; Akyol, Yeşim; Menekşe, Elif

doi:10.1345/aph.1e593

Cited by 77 publications

(71 citation statements)

References 17 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, clinically significant DDIs have been reported with atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin when used in combination with colchicine. [170][171][172][173][174][175][176][177][178][179][180][181][182] The DDI between colchicine and simvastatin is the most frequently reported in the literature, having been the subject of 6 cases. In each case, simvastatin-colchicine combination therapy resulted in myopathy, and 1 case progressed to rhabdomyolysis, multiorgan failure, and death.…”

Section: Miscellaneous Agents Colchicinementioning

confidence: 99%

Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Wiggins¹,

Saseen²,

Page³

et al. 2016

Circulation

235

194

View full text Add to dashboard Cite

A drug-drug interaction (DDI) is a pharmacokinetic or pharmacological influence of 1 medication on another that differs from the known or anticipated effects of each agent alone.1 A DDI may result in a change in either drug efficacy or drug toxicity for 1 or both of the interacting medications.2 Pharmacokinetic DDIs result in altered absorption, distribution, metabolism, or excretion of a medication. A pharmacodynamic DDI occurs when 1 medication modifies the pharmacological effect of another in an additive, a synergistic, or an antagonistic fashion.It is estimated that ≈2.8% of hospital admissions occur as a direct result of DDIs. 3 However, the actual incidence of hospitalization secondary to clinically significant DDIs is likely to be highly underestimated because medication-related issues are more commonly reported as adverse drug reactions. Complex underlying disease states also may make recognizing a DDI more challenging, further contributing to a lower reported incidence. The overall clinical impact of a DDI can range from mild to life-threatening. Therefore, not all DDIs require a modification in therapy. The variability in the clinical significance of a DDI depends on both medication-specific and patient-specific factors. Medication-specific factors include the individual pharmacokinetic characteristics of each medication implicated in the DDI (eg, binding affinity, half-life [t 1/2 ]), dose of the medications, serum concentrations, timing and sequence of administration, and duration of therapy. Patient-specific factors include age, sex, lifestyle, genetic polymorphisms causing differences in enzyme expression or activity, and disease impairment affecting drug metabolism (eg, hepatic or renal impairment, cardiac failure) or predisposition to differences in efficacy or safety (eg, statin intolerance in patients with a history of myopathy). Clinically significant DDIs are usually preventable. To optimize patient safety, healthcare providers must have an understanding of the mechanisms, magnitude, and potential consequences of any given DDI. Interpreting this information will assist clinicians in the safe prescribing of medications and permits careful consideration of the benefits and risks of concomitant medications.Statins reduce morbidity and mortality in patients with known atherosclerotic cardiovascular disease (ASCVD) and in many primary prevention patients.4-9 Current guidelines recommend high-intensity statin therapy in all patients with ASCVD age ≤75 years and moderate-to high-intensity statin therapy in patients with ASCVD and age >75 years, diabetes mellitus, and familial hypercholesterolemia and in primary prevention patients with 10-year ASCVD risk ≥7.5%.10 Given the important role of statins in patients with ASCVD and those at high ASCVD risk, combination therapy with statins and other cardiovascular medications is highly likely, and potentially significant DDIs must be considered in patients treated with statins.Another important aspect of prescribing medications in combination is evalu...

show abstract

Section: Miscellaneous Agents Colchicinementioning

confidence: 99%

Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Wiggins¹,

Saseen²,

Page³

et al. 2016

Circulation

235

194

View full text Add to dashboard Cite

show abstract

“…Also, a warning to avoid the co-prescription of colchicine and claritromycin because of increased colchicine toxicity has been published [57]. A report on colchicine related myotoxicity [58] in a patient receiving pravastatin has been published [59]. Selection between the different therapeutic options for gout inflammation remains empirical, and controlled studies between the different therapeutic groups would be welcomed.…”

Section: Treatment Of Gout-related Inflammationmentioning

confidence: 99%

Therapeutic advances in gout

Pascual

Sivera

2007

Current Opinion in Rheumatology

View full text Add to dashboard Cite

show abstract

“…10 In fact, many acute cases of muscle toxicity have been reported in patients concomitantly taking statins and colchicine. [11][12][13][14][15][16][17][18][19][20] Statins reportedly induce colchicine treatment is associated with an autophagic vacuolar myopathy in human patients. The presumed mechanism of colchicine-induced myotoxicity is the destabilization of the microtubule system that leads to impaired autophagosome-lysosome fusion and the accumulation of autophagic vacuoles.…”

Section: Introductionmentioning

confidence: 99%