Aggressive fluid management is the cornerstone of therapy. The general treatment is supportive and comprises immediate discontinuation of the offending drug. Statins are now well-established drugs with proven effectiveness for the reduction of adverse cardiovascular and cerebrovascular events. There is no antidote to reverse the myopathy or rhabdomyolysis caused by statins. Cholesterol is an essential component for fetal and infant synthesis of steroids and cell membrane development. Statins are contraindicated during pregnancy and while breastfeeding because of the effects on the cholesterol pathway. Statins are contraindicated for use by patients with active hepatic disease or unexplained persistent elevations in aminotransferase levels. Dose restrictions are recommended with the coadministration of gemfibrozil or other fibrates with statins, and the use of more than one statin is not recommended. Simvastatin and gemfibrozil coadministration is contraindicated because of the risk of rhabdomyolysis. Administration with other drugs associated with myopathy requires caution. A reduced dose may be appropriate or a selection of an alternative statin that does not undergo metabolism via the 3A4 pathway.
Ĭoadministration of CYP3A4 substrate statins (atorvastatin, lovastatin, and simvastatin) with medications that are potent 3A4 inhibitors (diltiazem, erythromycin, -azoles) may result in increased serum concentrations with an increased risk of side effects. The choice of agent should have its basis on patient-specific characteristics, the pharmacokinetic profiles of each medication, and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. The approved FDA indications vary slightly between the medications in this class but, in general, have recommendations for the treatment of atherosclerosis, myocardial infarction prophylaxis, and stroke prophylaxis. The primary use of these agents is for the primary and secondary prevention of coronary artery disease. Clinicians have long used statin medications for the treatment of hypercholesterolemia, hyperlipoproteinemia, and hypertriglyceridemia as an adjunct to diet and exercise. Hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, or statins, lower total cholesterol, low-density lipoprotein (LDL), and triglyceride concentrations while increasing high-density lipoprotein (HDL) concentrations.