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Statin macrolide interaction — DGM MCQ

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HardPolypharmacyStatin macrolide interactionDGM

An 86-year-old woman on apixaban for atrial fibrillation is prescribed clarithromycin for a chest infection. She also takes simvastatin, ramipril, metformin and paracetamol. Two days later she develops muscle pain and dark urine; CK is markedly raised. Which medication should be reviewed?

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Correct answer: D — Simvastatin

Clarithromycin can interact with simvastatin and increase risk of myopathy or rhabdomyolysis. Apixaban also has interaction considerations, but the muscle pain, dark urine and high CK point to statin toxicity. Interactions with short antibiotic courses are a frequent cause of acute prescribing harm.

Reference: BNF; STOPP/START criteria v3