Physicians' Academy for Cardiovascular Education

AHA Scientific Statement on management of drug-drug-interactions with statins

News - Oct. 19, 2016

The American Heart Association (AHA) has issued a scientific statement on how to manage drug-drug-interactions (DDIs) with statins in patients with atherosclerotic cardiovascular disease (ASCVD).
Statin therapy is recommended in most patients with ASCVD, or those at high risk of developing it. Statins are often given in combination with other CV medication, thus DDIs may occur. A DDI is a pharmacokinetic or pharmacological influence of one medication on another that alters the anticipated effect of the agents as when given alone. This may lead to a different drug efficacy or even drug toxicity.
DDIs can, directly or indirectly, lead to hospital admissions. About 2.8% of hospital admissions are
estimated to be a direct consequence of a DDI, but this is not always recognised as such; they are commonly reported as adverse drug reactions. A complex underlying disease state may also complicate recognition of a DDI.
Clinically significant DDIs are often preventable, notes the AHA Scientific Statement, thus awareness of the mechanisms and potential consequences can facilitate safe prescription of medication. To this end, the document reviews the basics of DDIs, the pharmacological differences of the various statins, and specific DDIs seen when statins are given concomitantly with other medications used in patients treated for CVD. Moreover, the magnitude and clinical significance of a DDI are relevant to consider, as situations are conceivable in which less-than-ideal medication combinations may need to be chosen in light of cost-effectiveness considerations.
The Scientific Statement provides recommendations on the clinical management of DDIs, specified for multiple CV drug classes and individual agents. The available evidence on potential DDIs with statins is summarised and guidance is formulated on how to optimally manage CVD treatment while minimising untoward effects. The document aims to help in early identification of DDIs, for evaluation and adequate management.


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

Wiggins BS, Saseen JJ, Page RL et al., 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 Functional Genomics and Translational Biology
Circulation. 2016;CIR.0000000000000456.
Originally published October 17, 2016
Find the AHA Scientific Statement online at Circulation

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