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Drug Interaction, Statin Safety — UKMLA MCQ

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HardPharmacologyDrug Interaction, Statin SafetyUKMLAMRCGP AKTPARAPSA

A patient taking rosuvastatin 20 mg daily needs a short course of clarithromycin. There is no suitable antibiotic alternative and he has no muscle symptoms. What statin advice is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Rosuvastatin can be continued at its usual dose, with counselling about muscle toxicity

A is correct. SPS distinguishes statins according to their metabolic and transporter pathways. Rosuvastatin undergoes limited CYP metabolism and can be continued with clarithromycin. Patients should nevertheless be counselled to report unexplained muscle pain, tenderness, weakness or dark urine because myopathy and rhabdomyolysis are important class toxicities. In contrast, simvastatin is contraindicated with clarithromycin, and atorvastatin should preferably be avoided or temporarily stopped; if unavoidable, atorvastatin is limited to 20 mg daily. Substituting simvastatin would therefore increase rather than reduce interaction risk, and no permanent change is required solely for this short course.

Reference: NHS SPS, Managing interactions between macrolides and statins: https://www.sps.nhs.uk/articles/managing-interactions-between-macrolides-and-statins/