Drug Interactions (don't take these with statins)

[cjbrooksjc]

Someone was asking for a list of drugs/foods that one should not take while on statin medication. I pulled these two excerpts from the NHLBI (Heart/Lung/Blood Inst.) papers and from the pharmacist's guide.

Do not take specific concomitant medications or consume items as
listed below (check specific statin package insert for warnings)

 Fibrates (especially gemfibrozil, but other fibrates too)
 Nicotinic acid (rarely)
 Cyclosporine
 Azole antifungals
 Itraconazole and ketoconazole
 Macrolide antibiotics
 Erythromycin and clarithromycin
 HIV protease inhibitors
 Nefazodone (antidepressant)
 Verapamil
 Amiodarone
 Large quantities of grapefruit juice (usually more than 1
quart per day)
 Alcohol abuse (independently predisposes to myopathy)

A more lay version is:

The statins may interact with other drugs, leading to a build-up in the body of the statin or the other drug being used. This may result in frequent or severe side effects. Whether a drug interaction is likely to occur will depend in part on which statin you are taking. Drugs that are likely to interact with statins include:
antacids (Tums, Maalox)
cyclosporine (Neoral)
erythromycin (Ery-Tab, E.E.S.)
gemfibrozil (Lopid)
niacin (Niaspan)
ketoconazole (Nizoral)
itraconazole (Sporonox)
clarithromycin (Biaxin), erythromycin
certain HIV medicines
warfarin (Coumadin)

and grapefruit (in quantity) and excessive alcohol.

Regards,

Brooks

[Biologist]

Thanks, Brooks, excellent post.

Here's another antibiotic to add to the list. BTW, this is part of the utility of this site. This information originates RIGHT HERE on this website -- not in the medical literature. We are often significantly ahead of the medical community. I have found this "warning" NOWHERE else on the Web and my prescribing dr. sure had no idea. How could she have? Its simply not listed. And apparently is STILL not listed and still being prescribed unknowingly to statin victims!

http://www.spacedoc.net/board/viewtopic.php?p=4846#4846

The included Cytochemistry Website also shows the mechanism.

Biologistbb

[jazzbird925]

I had a basal cell carcinoma removed via Mohs surgery in mid-October. Post op, I was put on a 5-day regime of twice daily 500 mg of the antibiodic Cefadroxil (Duricef).

I waited to begin Lescol until done with the antibiodic. I don't recall the specifics but most likely waited several days before starting Lescol - probably not enough to get the antibiodic out of my system.

My Lescol regime lasted less than 10 days due to leg pains. I discontinued the Lescol, waited a week or so and began Pravastatin for less than 6 weeks before terminating use do to pain and other issues. It's been approximately 8 weeks - no improvement.

Any thoughts on whether or not the statins and Cefadroxil interacted despite a lag time in-between use? Although not mentioned as a Cedadroxil interaction, as we all know, lack of documenation is not unusual............

[cjbrooksjc]

Biologist: The mitochondria link was very informative. I noticed in the 'Mito disease' segment, near the end of the paper, they refer to an 'inherited' eye problem that is the result of compromised CoQ10. Did you understand that?
The one helpful/hopeful thing I read was that damaged MtDna CAN BE repaired.
And another thing: I was not able to find out exactly HOW antibiotics interact with Statin drugs; what the physical result is... did you find that?

During my dance with Zocor I was twice treated with antibiotics for pneumonia (which I NEVER contracted prior to Statins). I am very interested in how that might have contributed to my condition.

Best,

Brooks

[Biologist]

Brooks,

Interesting questions. I have some thoughts but better wait for now. Busy with projects the last few days and today. There are a couple of posts I want to respond to when I get a chance. May be a few days.

(For one I want to track down the little rubber piece on the keyboard for my laptop used to control the curser. It did not survive a cleaning a while back of the computer and they are hard to find that will fit properly! Looks like I get to order one from Toshiba or get into the attic to maybe find its original case where there may have been spares. Otherwise I keep getting "bbbbbbbs" showing up in all my typing by hitting that key in trying to move the curser without the rubber piece -- more than you needed to know, right? :) ).

jazzbird925,

I think there could easily be such a reaction depending on the half-life of the given antibiotic. Note CNN today mentioning that statins and antibiotics are now showing up in municipal water supplies, along with sex hormones like estrogen. More on that another time, maybe...

Later,

Biologist

[cjbrooksjc]

Biologist: I used IBM laptops for quite a while and had the same prob. I took the eraser off my cross mechanical pencil, auger'ed a small hole in the bottom and used that; it worked for quite a while.

Otherwise - good hunting.

Brooks

[Ray Holder]

Some penicillin type antibiotics are listed as causing carnitine deficiency. As muscle problems from statins also come from carnitine deficiency, it is fair to assume that they would add to the statin damage in muscles.

Diltiazem is another heart/BP drug which prevents the disposal of statins from the body, now they tell me!!! I took that all of the four years of my encounter with statins.

Ray

[Biologist]

Brooks,

I signed on over an hour ago to post in this thread, but read one of your more recent posts first and spent all my time reading some of your hyperlinks. I agree that this one was absolutely excellent. Answers a lot of questions:

*http://www.drmyhill.co.uk/article.cfm?id=381

Hopefully I will get a chance to comment in this thread before long unless you keep putting up interesting hyperlinks !

BTW, I found the keyboard piece I was looking for and a lot of other things I had been missing (and didn't realize it) while looking for it. Nice. I recommend looking for stuff every now and then just to see what else shows up in the process. Thanks for the hypelink.

Biologist

[cjbrooksjc]

Biologist: Yes, drmyhill CFS link, that one had me involved for quite a while. AND, after 35 yrs of marriage and two people "tidying", the words "Oh, there that is. I looked all over for that!" ring loud and often in the house.

Brooks

[Biologist]

OK, I'll take a shot at it now:

"...they refer to an 'inherited' eye problem that is the
result of compromised CoQ10. Did you understand
that?"
--Brooks

An *inherited* mitochondrial mutation, which generally implies that ALL the mitochondrial units in every cell of the body are effected, will show the most pathology in tissues and organs where ATP demand is highest -- such as for the optic nerves. There's a huge demand there! The specific type of mutation they cite apparently has to do with compromised DNA instructions for the construction of a part (i.e., a subunit) of a particular mitochondrial protein, the NADH-C0Q reductase enzyme. The loss of that enzyme (or is impaired function, limiting ATP production) shows up most spectacularly in the optic nerve due to very high power demands there, but we can be sure it impairs many other organs and systems throughout the body as well. Note that we do not face inherited mitochondrial mutations, but rather impaired mitochondria function of various types and origins -- Beatup Mitochondria Syndrome (to coin a term). Some of these defects may involve *acquired* mutations to the mitochondrial DNA of some units (such that daughter cells will replicate the error); but some of the defects may be correctable with improved conditions (e.g., improved cellular carnitine availability) such that the unit can get back on its feet again and its future division will be fine; and of course, some are so screwed up they just die, which is OK, as there are so many of them in each cell which can be replaced by good ones dividing. Most of our bodies' hundreds of trillions of mitochondria are fine or have limited damage that is not passed on to daughter cells. (BTW, note the comment that kids can survive fine with only 15% of mitochondrial units functioning.) I suspect we are much are better off than those with serious "global loss" from any particular mitochondrial mutation that consistently precludes the production of particular proteins for optimal function in all mitochondrial units such as in the disease they cite.

"I was not able to find out exactly HOW antibiotics
interact with Statin drugs; what the physical result
is... did you find that?"
--Brooks

The antibiotic provides the "additional insult" of selectively knocking out a mitochondrion's ability to produce one of more of the very few vital proteins that it makes (i.e, codes for and constructs) on-site to maintain and repair itself. It blocks production. Such a temporary impairment of protein production due to a course of antibiotics is survivable to a healthy mitochondrial unit, but not one screwed up by statins. There appears to be a synergism of impairment created by the two that pushes the unit over the edge -- to either death or permanent or semi-permanent dysfunction. It's like the Enterprise taking a Klingon photon torpedoe (the antibiotic) while the shields are down (due to statins).

Biologist

[cjbrooksjc]

Biologist: Thought I'd take another shot at the forum before I went to bed and found your reply.

1. Inherited eye prob: OK, I was confused about the time line. They meant the Q10 compromise was innate and did not develop later. I read a event timing conflict where there was none. Mitochondrial Disease vs. Mitochondrial Disfunction - I understand. Such a fascinating cytological drama... wish to hell I knew NOTHING ABOUT IT!!

2. Ah, now this probably explains why I took such a dive after my bout of statin-induced Pneumonia. The Dr. gave me boatloads of antibiotics (misguided child of an unwed mother!!). Enterprise?... I think I had been reduced to a space shuttle by that time. I am simply hoping my body can shed the borked mitos and/or repair them in time for me to enjoy life again before they take my driver's license in defense of the general public.

Complete, concise explanations. I thank you.

Brooks

[flacorps]

Don't forget that the grapefruit juice warning is dangerously incomplete.

Grapefruit contains two components relevant to the inquiry: furanocoumarins (bergamottin and its analogues) and flavonoids (which inhibit P-glycoprotein). The former act in the liver, the latter act in the kidneys, and the interaction of both keeps a statin from being eliminated, resulting over time in an overdose.

Grapefruit juice is not the only source of these compounds, and perhaps not the most potent source of the former. Lemon and lime oils are widely used in flavorings, they are loaded with furanocoumarins, and in many items ingredients that render them harmless (like citric acid) are absent.

Meanwhile, flavonoids abound [i]without[/i] furanocoumarins in items like orange juice.

Someone who unknowingly mixes the two ... is going to get a surprise [i]grapefruit juice effect[/i].