High rates of adverse effects and patient unawareness of withdrawn lipid‐lowering drug combination in a public hospital clinic

Purpose Examine use, patient awareness and outcomes of concurrent cerivastatin and gemfibrozil in a public hospital clinic system 2 weeks following cerivastatin withdrawal. Methods Electronic pharmacy records for cerivastatin prescriptions for 1 year preceding withdrawal were downloaded and linked to gemfibrozil prescriptions. Patients with concurrent prescriptions were surveyed for current use, awareness of withdrawal/warnings, adverse effects and creatine phosphokinase (CK) results. Results From August 2000 to August 2001, 29 377 prescriptions for cerivastatin were dispensed for 10 780 unique patients; 211 (2%) also received gemfibrozil. Prescription time frames for the two drugs overlapped for 67 patients. Interview of 47 patients revealed 35 actually taking both. 18/35 (51.4%) were still taking both drugs 2 weeks after market‐withdrawal of cerivastatin. Only 7/46 (21.2%) had ‘heard the news’ about withdrawal. 19/46 (41.3%) described muscle‐related symptoms; nine reported severe symptoms. Only 13 (28.3%) had CK monitoring. 5/8 symptomatic patients monitored had CK values >200 U/L. (>1000 U/L in two cases.) Conclusions Despite escalating labeled warnings, nearly 2% of patients prescribed cerivastatin received gemfibrozil prescriptions, 1/3 concurrently. Most were still taking this combination 2 weeks after cerivastatin withdrawal and unaware of publicized warnings. Nearly half experienced muscle‐related symptoms. More reliable methods for preventing prescription/dispensing of interacting medications and alerting patients about drug recalls are warranted. Copyright © 2002 John Wiley & Sons, Ltd.