-
Notifications
You must be signed in to change notification settings - Fork 5
Commit
This commit does not belong to any branch on this repository, and may belong to a fork outside of the repository.
- Loading branch information
Yifan Ning
committed
Sep 2, 2016
1 parent
6276d01
commit 565b4e0
Showing
1 changed file
with
53 additions
and
0 deletions.
There are no files selected for viewing
This file contains bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
| Original file line number | Diff line number | Diff line change |
|---|---|---|
| @@ -0,0 +1,53 @@ | ||
| <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> | ||
| <!-- saved from url=(0052)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/ --> | ||
| <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><head><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> | ||
|
|
||
| <body class="article" id="ui-jig-5"> | ||
|
|
||
| <div class="grid"> | ||
| <div class="content"> | ||
| <div id="maincontent" class="content eight_col col"> | ||
| <div class=""> | ||
|
|
||
| <div class="hide-overflow article lit-style content pmc-wm slang-all page-box"><!--main-content--> | ||
| <div class="jig-ncbiinpagenav" data-jigconfig="smoothScroll: false, allHeadingLevels: ['h2'], headingExclude: ':hidden'" id="ui-jig-1"> | ||
|
|
||
| <h1 class="content-title">Simvastatin co‐prescribed with protease inhibitors despite dangerous drug interactions</h1> | ||
| <div class="half_rhythm"> | ||
| <div class="contrib-group fm-author"><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Coyne%20KM%5Bauth%5D">Katherine M Coyne</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Boffito%20M%5Bauth%5D">Marta Boffito</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Theobald%20N%5Bauth%5D">Nick Theobald</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Asboe%20D%5Bauth%5D">David Asboe</a> | ||
| </div> | ||
| </div> | ||
| <div class="fm-panel small half_rhythm"> | ||
| <div class="fm-authors-info fm-panel hide half_rhythm" id="id965226_ai" style="display:none"> | ||
| <div class="fm-affl" lang="en"><strong>Katherine M Coyne</strong>, <strong>Marta Boffito</strong>, <strong>Nick Theobald</strong>, <strong>David Asboe</strong>, Chelsea and Westminster NHS Foundation Trust, London, UK</div> | ||
| <div id="__correspid385327">Correspondence to: Katherine Coyne<br>St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; [email protected]</div> | ||
| </div> | ||
| <div class="togglers"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#" class="pmctoggle" rid="id965226_ai">Author information <span>►</span></a> <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#" class="pmctoggle" rid="id965226_an">Article notes <span>►</span></a> <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#" class="pmctoggle" rid="id965226_cpl">Copyright and License information <span>►</span></a></div> | ||
| <div class="fm-article-notes fm-panel hide half_rhythm" id="id965226_an" style="display:none"> | ||
| <div class="fm-pubdate half_rhythm">Accepted 2007 May 11.</div></div><div class="fm-cpl-info fm-panel hide half_rhythm" id="id965226_cpl" style="display:none"> | ||
|
|
||
| <div class="fm-copyright half_rhythm"><a href="http://www.ncbi.nlm.nih.gov/pmc/about/copyright.html">Copyright</a> © 2007 BMJ Publishing Group</div></div> | ||
| </div> | ||
| </div> | ||
|
|
||
|
|
||
| <div id="__bodyid386988" class="tsec sec headless whole_rhythm"><p id="__p1" class="p p-first">Drug interactions with anti‐retrovirals are frequent and can be dangerous. Protease inhibitors (PIs) inhibit the metabolism of simvastatin, and co‐administration is contraindicated. Despite this, we have seen a recent cluster of patients prescribed simvastatin whilst on PIs.</p><p id="__p2">A 58‐year‐old man was taking abacavir, lamivudine, atazanavir and ritonavir. His HIV physician noted raised cholesterol and wrote to the patient and his general practitioner (GP), stating that simvastatin is not recommended with his antiretroviral combination, but low dose atorvastatin or pravastatin is safe. Simvastatin was prescribed by the GP.</p><p id="__p3">A 52‐year‐old woman was taking didanosine, efavirenz, atazanavir and ritonavir, as well as gliclazide, doxazosin and bendrofluazide. A letter from her HIV physician to her GP listed her medications and mentioned that her cholesterol was 8.5. Her GP started simvastatin. The patient took the first dose but stopped after reading the medication insert leaflet.</p><p id="__p4">A 53‐year‐old man was taking stavudine, lamivudine and nelfinavir. Pravastatin was started by his HIV physician, and letters were written regularly to his GP about current medications. Pravastatin was changed to simvastatin by his GP 6 years later.</p><p id="__p5">At least four other patients at our centre on protease inhibitors (PIs) have recently been switched to simvastatin by GPs. None have suffered adverse consequences, although similar cases have resulted in rhabdomyolysis and death.<sup><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#ref1" rid="ref1" class=" bibr popnode tag_hotlink tag_tooltip" id="__tag_181265740" role="button" aria-expanded="false" aria-haspopup="true">1</a></sup></p><p id="__p6">PIs, including ritonavir, atazanavir, lopinavir, saquinavir and nelfinavir, inhibit cytochrome P450 (CYP) 3A4 activity, which metabolises simvastatin and atorvastatin. Simvastatin exposure is increased by up to 3000% by PIs,<sup><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#ref2" rid="ref2" class=" bibr popnode tag_hotlink tag_tooltip" id="__tag_181265741" role="button" aria-expanded="false" aria-haspopup="true">2</a></sup> and co‐administration is contraindicated. Atorvastatin concentrations are increased by a much smaller margin, and atorvastatin may be used cautiously. Pravastatin and rosuvastatin are not metabolised by CYP3A4 and are safe to use with PIs.</p><p id="__p7">It should also be noted that efavirenz, a non‐nucleoside reverse transcriptase inhibitor, is an inducer of CYP3A4 metabolism, and reduces the concentrations of active simvastatin, atorvastatin and pravastatin by 58%, 34% and 40%, respectively.<sup><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#ref3" rid="ref3" class=" bibr popnode tag_hotlink tag_tooltip" id="__tag_181265739" role="button" aria-expanded="false" aria-haspopup="true">3</a></sup></p><p id="__p8" class="p p-last">GPs, and all physicians, are under pressure to prescribe cheaper medications where possible, and this is driving the switch to simvastatin. Simvastatin is also available without prescription in pharmacies. These cases highlight the importance of effective communication between HIV physicians, GPs and the patient, not only about current medications but also about potential drug interactions. Where PIs are being used, simvastatin must be avoided.</p></div> | ||
|
|
||
| <div id="__fn-groupid384859" class="tsec sec"> | ||
| <div class="goto jig-ncbiinpagenav-goto-container" id="ui-jig-7"><span role="menubar"><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#" title="Go to other sections in this page" role="menuitem" aria-expanded="false" aria-haspopup="true" id="ui-jig-8">Go to:</a></span></div><h2 class="head no_bottom_margin ui-helper-clearfix" id="__fn-groupid384859title">Footnotes</h2><!--back/fn-group--> | ||
| <div class="fm-sec half_rhythm small"><p class="fn sec" id="__fnid384860"> </p><p id="__p9" class="p p-first-last">Competing interests: None.</p><p></p><p class="fn sec" id="__fnid384868"></p><p id="__p10" class="p p-first-last">Informed consent was obtained for publication of the patients' details in this report.</p><p></p></div></div> | ||
| <div id="__ref-listid384876" class="tsec sec"> | ||
| <div class="goto jig-ncbiinpagenav-goto-container" id="ui-jig-9"><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#" title="Go to other sections in this page" role="button" aria-expanded="false" aria-haspopup="true" id="ui-jig-10">Go to:</a></div><h2 class="head no_bottom_margin ui-helper-clearfix" id="__ref-listid384876title">References</h2> | ||
| <div class="ref-list-sec sec" id="reference-list"> | ||
| <div class="ref-cit-blk half_rhythm" id="ref1">1. <span class="citation">Hare C B, Vu M P, Grunfeld C. <em>et al</em> Simvastatin‐nelfinavir interaction implicated in rhabdomyolysis and death. <span class="ref-journal">Clin Infect Dis</span> 2002<span class="ref-vol">35</span>e111–e112.e112 <span class="nowrap ref pubmed">[<a href="http://www.ncbi.nlm.nih.gov/pubmed/12410494" target="pmc_ext" ref="reftype=pubmed&article-id=2598705&issue-id=174367&journal-id=176&FROM=Article%7CCitationRef&TO=Entrez%7CPubMed%7CRecord&rendering-type=normal">PubMed</a>]</span></span></div> | ||
| <div class="ref-cit-blk half_rhythm" id="ref2">2. <span class="citation">Fichtenbaum C J, Gerber J G, Rosenkranz S L. <em>et al</em> Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047. <span class="ref-journal">AIDS</span> 2002<span class="ref-vol">16</span>569–577.577 <span class="nowrap ref pubmed">[<a href="http://www.ncbi.nlm.nih.gov/pubmed/11873000" target="pmc_ext" ref="reftype=pubmed&article-id=2598705&issue-id=174367&journal-id=176&FROM=Article%7CCitationRef&TO=Entrez%7CPubMed%7CRecord&rendering-type=normal">PubMed</a>]</span></span></div> | ||
| <div class="ref-cit-blk half_rhythm" id="ref3">3. <span class="citation">Gerber J G, Rosenkranz S L, Fichtenbaum C J. <em>et al</em> Effect of efavirenz on the pharmacokinetics of simvastatin, atorvastatin, and pravastatin: results of AIDS Clinical Trials Group 5108 Study. <span class="ref-journal">J Acquir Immune Defic Syndr</span> 2005<span class="ref-vol">39</span>307–312.312 <span class="nowrap ref pubmed">[<a href="http://www.ncbi.nlm.nih.gov/pubmed/15980690" target="pmc_ext" ref="reftype=pubmed&article-id=2598705&issue-id=174367&journal-id=176&FROM=Article%7CCitationRef&TO=Entrez%7CPubMed%7CRecord&rendering-type=normal">PubMed</a>]</span></span></div></div></div> | ||
| <div style="display: none; width: 200px; top: -100px; left: -100px;" aria-live="assertive" aria-hidden="true" class="ui-helper-reset ui-ncbipopper-wrapper ui-ncbilinksmenu"><ul id="ui-ncbiinpagenav-2"><li><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#__fn-groupid384859title">Footnotes</a></li><li><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598705/#__ref-listid384876title">References</a></li></ul></div></div><!--post-content--><hr class="whole_rhythm no_bottom_margin"> | ||
| <div class="courtesy-note no_margin small">Articles from <span class="acknowledgment-journal-title">Sexually Transmitted Infections</span> are provided here courtesy of <strong>BMJ Group</strong></div> | ||
| </div> | ||
|
|
||
| </div> | ||
| </div> | ||
| </div> | ||
| </body> | ||
| </html> |