ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015
Risk of adverse events among older adults following co-prescription of clarithromycin and statins not metabolized by cytochrome P450 3A4.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
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30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 71 citations in OpenAlex.
- Risk of antimicrobial-associated organ injury among the older adults: a systematic review and meta-analysis.BMC geriatrics · 2021Pooled it
- Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients.The Journal of antimicrobial chemotherapy · 2019Pooled it
- Simvastatin Improves Neutrophil Function and Clinical Outcomes in Pneumonia. A Pilot Randomized Controlled Clinical Trial.American journal of respiratory and critical care medicine · 2019Trial
- Machine learning models for drug-drug interaction prediction from computational discovery to clinical application.NPJ digital medicine · 2026Review
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- Adverse events with co-prescription of angiotensin receptor blockers and clarithromycin compared to azithromycin: A population-based retrospective cohort study.Pharmacotherapy · 2025Article
- Clinically important pharmacokinetic drug-drug interactions with antibacterial agents.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024Review
- Use of proton pump inhibitors and macrolide antibiotics and risk of acute kidney injury: a self-controlled case series study.BMC nephrology · 2022Article
- Rhabdomyolysis triggered by azithromycin.Journal of family medicine and primary care · 2022Article
- Leveraging National Claims and Hospital Big Data: Cohort Study on a Statin-Drug Interaction Use Case.JMIR medical informatics · 2021Article
- Azithromycin: A promising treatment option forJournal of clinical tuberculosis and other mycobacterial diseases · 2021Article
- Association of proton pump inhibitors and concomitant drugs with risk of acute kidney injury: a nested case-control study.BMJ open · 2021Article
- Prediction of potential drug interactions between repurposed COVID-19 and antitubercular drugs: an integrational approach of drug information software and computational techniques data.Therapeutic advances in drug safety · 2021Article
- Research Advances in Cardio-Cerebrovascular Diseases ofFrontiers in pharmacology · 2021Review
- Article
- Statins for primary prevention of cardiovascular disease and the risk of acute kidney injury.Pharmacoepidemiology and drug safety · 2019Article
- Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019Article
- Statins: a viable candidate for host-directed therapy against infectious diseases.Nature reviews. Immunology · 2019Review
- Outcomes Following Macrolide Use in Kidney Transplant Recipients.Canadian journal of kidney health and disease · 2019Article
- The clinical significance of statins-macrolides interaction: comprehensive review of in vivo studies, case reports, and population studies.Therapeutics and clinical risk management · 2019Article
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12 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe cytochrome P450 3A4 (CYP3A4) inhibitor clarithromycin may also inhibit liver-specific organic anion-transporting polypeptides (OATP1B1 and OATP1B3). We studied whether concurrent use of clarithromycin and a statin not metabolized by CYP3A4 was associated with an increased frequency of serious adverse events.
methodsUsing large health care databases, we studied a population-based cohort of older adults (mean age 74 years) who were taking a statin not metabolized by CYP3A4 (rosuvastatin [76% of prescriptions], pravastatin [21%] or fluvastatin [3%]) between 2002 and 2013 and were newly prescribed clarithromycin (n=51,523) or azithromycin (n=52,518), the latter an antibiotic that inhibits neither CYP3A4 nor OATP1B1 and OATP1B3. Outcomes were hospital admission with a diagnostic code for rhabdomyolysis, acute kidney injury or hyperkalemia, and all-cause mortality. All outcomes were assessed within 30 days after co-prescription.
resultsCompared with the control group, patients co-prescribed clarithromycin and a statin not metabolized by CYP3A4 were at increased risk of hospital admission with acute kidney injury (adjusted relative risk [RR] 1.65, 95% confidence interval [CI] 1.31 to 2.09), admission with hyperkalemia (adjusted RR 2.17, 95% CI 1.22 to 3.86) and all-cause mortality (adjusted RR 1.43, 95% CI 1.15 to 1.76). The adjusted RR for admission with rhabdomyolysis was 2.27 (95% CI 0.86 to 5.96). The absolute increase in risk for each outcome was small and likely below 1%, even after we considered the insensitivity of some hospital database codes.
interpretationAmong older adults taking a statin not metabolized by CYP3A4, co-prescription of clarithromycin versus azithromycin was associated with a modest but statistically significant increase in the 30-day absolute risk of adverse outcomes.
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