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Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study
- Source :
- PLoS ONE, Vol 8, Iss 8, p e69545 (2013), PLoS ONE
- Publication Year :
- 2013
- Publisher :
- Public Library of Science (PLoS), 2013.
-
Abstract
- PurposeTo 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.MethodsCross-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.ResultsOR 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), (pConclusionsPrescribers 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.
- Subjects :
- Male
Non-Clinical Medicine
Epidemiology
Health Care Providers
Atorvastatin
Pharmacology
Endocrinology
Drug Metabolism
Gemfibrozil
Drug Interactions
Registries
Aged, 80 and over
Multidisciplinary
Clinical Pharmacology
Middle Aged
Medicine
Female
lipids (amino acids, peptides, and proteins)
Research Article
medicine.drug
Adult
Drugs and Devices
medicine.medical_specialty
Statin
Adolescent
medicine.drug_class
Science
Cardiovascular Pharmacology
Medication Adherence
Young Adult
Adverse Reactions
Muscular Diseases
Internal medicine
medicine
Humans
Pharmacokinetics
Rosuvastatin
Amlodipine
cardiovascular diseases
Health Care Quality
Aged
Drug Labeling
Retrospective Studies
Sweden
business.industry
Pharmacoepidemiology
nutritional and metabolic diseases
Cross-Sectional Studies
Simvastatin
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Pravastatin
Fluvastatin
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 8
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....fb81660647ee721bd6fa58f817b13e92