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Author: Admin | 2025-04-28
Data on such a drug interaction, clinicians should be cautious when coprescribing atorvastatin and clopidogrel.7Other statins, including simvastatin and fluvastatin, were also evaluated for clinically significant drug interactions with clopidogrel. Siepmann et al8 conducted a double-blind, double-dummy, randomized, 2-period crossover study that evaluated clopidogrel with simvastatin or fluvastatin. Although the investigators reported no significant findings with clopidogrel and fluvastatin, they did report a significant finding with simvastatin regarding prothrombin time. However, coadministering clopidogrel with simvastatin did not affect or inhibit platelet aggregation. Fluvastatin was expected to not have a drug interaction because it is metabolized mainly by CYP2C9.8Despite rosuvastatin being partially metabolized by CYP2C9 and not CYP3A4, this statin was still studied for possible drug interactions with clopidogrel. In a clinical study by Pinheiro et al, patients with stable coronary artery disease were on concomitant use of rosuvastatin 40 mg daily while on both the loading and maintenance doses (300 mg and 75 mg, respectively) of clopidogrel.9 After 1 week of clopidogrel, rosuvastatin had about a 40% increase in blood concentration. Because rosuvastatin is active independently of its metabolization, concurrent use of clopidogrel therapy does not reduce rosuvastatin’s benefits, nor does it decrease the efficacy of clopidogrel. The significance of these 2 medications together is undetermined, as they do not work on the same enzyme. However, clinicians should note that the increase in rosuvastatin concentration occurs concurrently but independently of either medication’s efficacy.9Although lovastatin, a lipophilic statin metabolized by CYP3A4, was not evaluated or studied for drug interaction with clopidogrel, it is inferred that there is no clinical significance regarding its effect on the activity of clopidogrel on platelet aggregation.10Although questionable data intuitively support drug—drug interactions between clopidogrel and statins, because of the shared CYP enzyme pharmacokinetics, actual significance is not supported by in vivo clinical trials. Nevertheless, this does not eliminate caution and proper screening in high-risk patients, especially because phenotypical outliers for various CYP enzymes may be less predictable without genetic testing. Although the literature acknowledges and confirms lab value fluctuations with statins concurrently taken with clopidogrel, health care providers should be aware providers should be aware that such variations are clinically significant but generally not therapeutically significant. Verina Mansour is a PharmD candidate at the Albany College of Pharmacy and Health Sciences (ACPHS) in New York.Amy T. Murdico, PharmD, BCPS, is the associate chief of pharmacy services, the PGY-1 pharmacy residency director, and the PGY-2 pain and palliative care pharmacy residency coordinator at Albany Stratton VA Medical Center in New York. She coordinates and precepts in the VA Learning Opportunities Residency intern program and is an adjunct advanced pharmacy practice experience preceptor for ACPHS and Western New England University in Springfield, Massachusetts.Jeffrey Fudin, PharmD, FCCP, FASHP, FFSMB, is CEO and founder of Remitigate LLC and the owner and managing editor of paindr.com. He is also an adjunct associate professor at Western New England University College of Pharmacy and Health Sciences, an adjunct associate professor of pharmacy practice and pain management at ACPHS, and the director of the
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