Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.

<h4>Purpose</h4>To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In pati...

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Autores principales:	Jennifer Settergren, Birgit Eiermann, Buster Mannheimer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3cfc5db8c1fa4e22beaab8f79163cde6
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spelling	oai:doaj.org-article:3cfc5db8c1fa4e22beaab8f79163cde62021-11-18T09:00:57ZAdherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.1932-620310.1371/journal.pone.0069545https://doaj.org/article/3cfc5db8c1fa4e22beaab8f79163cde62013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23940522/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Purpose</h4>To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased.<h4>Methods</h4>Cross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin) was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed.<h4>Results</h4>OR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60-1.25 and 0.92; 95% CI 0.69-1.23). Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56-0.68 and low dose 0.63; CI 0.58-0.68). Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55-0.76 and low dose 0.70; CI 0.63-0.78). Mean DDD (SD) for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149) compared to patients on statin monotherapy 127 (93), (p<0.001).<h4>Conclusions</h4>Prescribers may to some extent avoid co-prescription of statins with calcium blockers and fibrates with an increased risk of myopathy. We found no evidence for avoiding co-prescriptions of statins and antibiotics with an increased risk of statin-induced adverse drug reactions. Co-prescription of statins and gemfibrozil is paradoxically associated with a marked increased statin dose, further aggravating the risk for severe myopathy.Jennifer SettergrenBirgit EiermannBuster MannheimerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 8, p e69545 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jennifer Settergren Birgit Eiermann Buster Mannheimer Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
description	<h4>Purpose</h4>To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased.<h4>Methods</h4>Cross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin) was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed.<h4>Results</h4>OR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60-1.25 and 0.92; 95% CI 0.69-1.23). Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56-0.68 and low dose 0.63; CI 0.58-0.68). Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55-0.76 and low dose 0.70; CI 0.63-0.78). Mean DDD (SD) for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149) compared to patients on statin monotherapy 127 (93), (p<0.001).<h4>Conclusions</h4>Prescribers may to some extent avoid co-prescription of statins with calcium blockers and fibrates with an increased risk of myopathy. We found no evidence for avoiding co-prescriptions of statins and antibiotics with an increased risk of statin-induced adverse drug reactions. Co-prescription of statins and gemfibrozil is paradoxically associated with a marked increased statin dose, further aggravating the risk for severe myopathy.
format	article
author	Jennifer Settergren Birgit Eiermann Buster Mannheimer
author_facet	Jennifer Settergren Birgit Eiermann Buster Mannheimer
author_sort	Jennifer Settergren
title	Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
title_short	Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
title_full	Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
title_fullStr	Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
title_full_unstemmed	Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
title_sort	adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/3cfc5db8c1fa4e22beaab8f79163cde6
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Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.

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