Some elderly people also suffer from multiple chronic diseases such as hypertension, hyperlipidemia, diabetes, etc., and often require multiple drugs to be taken together. It is inevitable that the drugs may interact with each other, which may reduce the efficacy, or harm the body. It can even be life threatening. For example, the commonly used lipid-lowering drugs, statins, and macrolide antibiotics, clarithromycin, cannot be used at the same time.
A case of rhabdomyolysis syndrome caused by combination of clarithromycin and simvastatin has been reported abroad. This patient is 67 years old and suffers from coronary heart disease and chronic obstructive pulmonary disease (“COPD” for short). He usually takes 80 mg of simvastatin every night. Later, due to the worsening of chronic obstructive pulmonary disease, he also took clarithromycin 250 mg every day. . One month later, the patient developed pain and weakness in the shoulders and limbs, and a sharp increase in creatine kinase caused a sharp decline in renal function. He was clinically diagnosed as rhabdomyolysis syndrome.
Rhabdomyolysis syndrome refers to a series of clinical syndromes that cause muscle dissolution and myoglobin into the blood due to factors such as trauma, inflammation, or metabolic abnormalities caused by drugs. This happens because simvastatin needs an enzyme in the liver for metabolism in the body, and clarithromycin inhibits this enzyme. The combination of the two drugs will increase the blood concentration of simvastatin in the body and prolong the residence time. Statins have their own adverse reactions that cause myalgia and muscle weakness, but clinical application is generally safer, and the probability of rhabdomyolysis syndrome is relatively rare. And this patient received 80 mg of simvastatin daily, which is the maximum dose for clinical application. Studies have found that the greater the dose of statins, the higher the incidence of myotoxicity. When clarithromycin is used in combination, its metabolism will be inhibited, its residence time in the body will be prolonged, and it will eventually cause rhabdomyolysis syndrome.
Among antibacterial drugs, in addition to clarithromycin which can inhibit the metabolism of simvastatin and lovastatin, erythromycin is also an inhibitor of this metabolic enzyme. Therefore, patients taking statins should prohibit the combined use of clarithromycin and erythromycin.
Small link: Precautions for taking statins
So far, statins are still the first choice and cornerstone drugs for regulating blood lipids in clinical practice. In addition to effective lowering of low-density lipoprotein cholesterol, statins can effectively reduce the risk of cardiovascular diseases. In addition to reducing blood lipids, long-term use of statins can also stabilize plaque and prevent cardiovascular disease risks. .
However, long-term use of statins may cause abnormal liver function and elevated aminotransferases. Therefore, during the period of taking statins, aminotransferase should be checked regularly. If the aminotransferase rises by more than 3 times, the drug should be discontinued. In addition, long-term use of statins may cause muscle pain.
Therefore, during the period of taking statins, it is very important and necessary to monitor relevant indicators regularly, especially in the initial stage, to monitor liver function and blood sugar regularly.