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Simvastatin, ciprofloxacin, rhabdomyolysis, elderly, polypharmacy
A case report of a ciprofloxacin and simvastatin interaction is presented. The addition of ciprofloxacin to chronic simvastatin therapy led to the development of rhabdomyolysis. As ciprofloxacin is a weak inhibitor of CYP3A4, it is very likely that other mechanisms involving the ATP-binding cassette drug efflux transporter family played a role in this drug interaction
2. Roland M, Tozer TN. Variability. In: Roland M, Tozer TN, editors. Clinical pharmacokinetics. 2nd ed. Philadelphia: Lea and Febiger; 1989. p.197-212.
3. Herman RJ. Drug interactions and statins. CMAJ 1999;161(10):1281-6.
4. Tobert JA. Efficacy and long-term adverse effect pattern of lovastatin. Am J Cardiol 1988;62:28J-34J.
5. Pedersen TR, Berg K, Cook TJ, et al. Safety and tolerability of cholesterol lowering with simvastatin during 5 years in the Scandinavian simvastatin survival study. Arch Intern Med 1996;156:2085-92.
6. Grundy SM. HMG-CoA reductase inhibitors for treatment of hypercholesterolemia. N Engl J Med 1988;319:24-33.
7. Ucar M, Mjorndal T, Dahlqvist R. HMG- CoA reductase inhibitors and myotoxicity. Drug Safety 2000; 22:441–457.
8. Prueksaritanont T, Ma B, Yu N. The human hepatic metabolism of simvastatin hydroxy acid is mediated primarily by CYP3A, and not CYP2D6. Br J Clin Pharmacol 2003 July; 56(1):120–124.
9. Holtzman CW, Wiggins B, Spinler S. Role of p-gp in statin drug interactions. Pharmacotherapy.2006; 26:(11):1601-1607.
10. Alvarez AI, Pérez M, Prieto JG, Molina AJ, Real R, Merino G. Fluoroquinolone efflux mediated by ABC transporters. J Pharm Sci 2008 Sep; 97 (9):3483-93.