Top Things to Know: Recommendations for Management of Clinically Significant Drug-Drug Interactions with Statins and Select Agents used in Patients with Cardiovascular Disease
Published: October 17, 2016
- “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. A DDI may result in a change in either drug efficacy or drug toxicity for 1 or both of the interacting medications. 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.”
- “This statement provides a clinically relevant review of drug-drug interactions (DDI’s) for statin medications including the significance of statin DDIs with select medications used to treat patients with CV disease, recommendations on the clinical management of these DDIs, as well as pharmacokinetic studies to provide guidance on how statin DDIs with select medications utilized in cardiovascular patients should be managed.”
- “It is estimated that ≈2.8% of hospital admissions occur as a direct result of DDIs.”
- “Statin medications are commonly prescribed to reduce morbidity and mortality in patients with and at risk for ASCVD events. Statin DDIs in cardiovascular patients are often unavoidable and should be clinically managed.”
- “A clear understanding of the magnitude and clinical significance of DDIs will enable clinicians to make well-informed decisions to provide evidence-based and cost-effective health care as safely as possible.”
- “A review of all medications that statin-treated patients are taking should be done at each clinical encounter and during transitions of care within a health system so that DDIs can be identified early, evaluated, and managed appropriately by implementing doses adjustments, changing to a safer statin medication, or discontinuing when needed.”
- “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.”
- “This scientific statement will serve as a resource to providers about DDI’s with statins and enable them to evaluate the risks versus benefits when evaluating the whole patient who now needs statins as a part of their therapy.”
Citation
Wiggins BS, Saseen JJ, Page RL 2nd, Reed BN, Sneed K, Kostis JB, Lanfear D, Virani S, Morris PB; on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology; Council on Hypertension; Council on Quality of Care and Outcomes Research; and Council on Genomic and Precision Medicine. 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 [published online ahead of print October 17, 2016]. Circulation. doi: 10.1161/CIR.0000000000000456.