Which action is most appropriate when a patient on simvastatin starts clarithromycin for a chest infection?

Which action is most appropriate when a patient on simvastatin starts clarithromycin for a chest infection?

• A. Continue simvastatin
• B. Reduce simvastatin dose
• C. Stop simvastatin immediately and refer
• D. Switch to rosuvastatin

Answer: (C)

Clarithromycin strongly inhibits the liver enzyme that breaks down simvastatin. With this inhibition, simvastatin levels rise, increasing the risk of muscle toxicity, including rhabdomyolysis. Because of this significant interaction, the safest action is to stop simvastatin during the antibiotic course and have the prescriber decide how to proceed after the infection is treated. Simply reducing the dose does not reliably prevent toxicity, and continuing the statin at any dose during clarithromycin exposure is risky. The prescriber can determine whether to restart the statin or switch to a non-interacting option after or around the course of antibiotics.

Clarithromycin strongly inhibits the liver enzyme that breaks down simvastatin. With this inhibition, simvastatin levels rise, increasing the risk of muscle toxicity, including rhabdomyolysis. Because of this significant interaction, the safest action is to stop simvastatin during the antibiotic course and have the prescriber decide how to proceed after the infection is treated. Simply reducing the dose does not reliably prevent toxicity, and continuing the statin at any dose during clarithromycin exposure is risky. The prescriber can determine whether to restart the statin or switch to a non-interacting option after or around the course of antibiotics.