Statin Toxicity with Macrolide Coprescription

Coadministration of cytochrome P₄₅₀ isoenzyme 3A4 (CYP3A4)–inhibiting macrolide antibiotics (clarithromycin or erythromycin, but not azithromycin) with atorvastatin, simvastatin, or lovastatin (which are metabolized by CYP3A4), is associated with a 4- to 10-fold increase in statin concentration. Moreover, case reports have documented serious adverse consequences, including rhabdomyolysis and death, from clarithromycin- or erythromycin-related statin toxicity. In this study, researchers in Canada examined administrative databases to assess toxicity in 144,000 older users of atorvastatin, simvastatin, or lovastatin (age, >65) who were coprescribed clarithromycin or erythromycin during 2003 through 2010.

Compared with azithromycin, coprescripti…