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Statin‐induced rhabdomyolysis from azithromycin interaction in a patient with heterozygous SLCO1B1 polymorphism
Author(s) -
Burns Hailey,
Russell Landon,
Cox Zachary L.
Publication year - 2021
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.13327
Subject(s) - slco1b1 , rhabdomyolysis , azithromycin , medicine , statin , pharmacogenetics , polymorphism (computer science) , pharmacology , genotype , genetics , biology , antibiotics , gene
What is known and objective Unlike other macrolide antibiotics, azithromycin is considered safe to co‐prescribe with simvastatin. We aim to elucidate the mechanism of a rare azithromycin‐simvastatin interaction. Case description We report a case of simvastatin‐induced rhabdomyolysis caused by an azithromycin drug interaction in a patient with heterozygous SLCO1B1 loss‐of‐function polymorphism. We propose a dual‐hit mechanism for this drug‐drug‐genome interaction. Azithromycin mildly inhibits simvastatin's CYP 3A4 hepatic metabolism, and the SLCO1B1 polymorphism reduces simvastatin hepatic uptake. The combination increases simvastatin serum concentrations significantly, inducing rhabdomyolysis. What is new and conclusion Patients with statin‐induced myopathy associated with non‐classic CYP inhibitors should be considered for genetic testing and alternative statins with less risk of future interactions.