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Statin and macrolide interaction — GPhC CRA MCQ

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HardDrug InteractionsStatin and macrolide interactionGPhC CRA

A 54-year-old man taking atorvastatin 80mg nightly is prescribed clarithromycin 500mg twice daily for 7 days. He has CKD stage 3 and previous statin-associated myalgia. What is the most appropriate action?

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Correct answer: E — Contact the prescriber to consider withholding atorvastatin during clarithromycin treatment

Clarithromycin inhibits CYP3A4 and can increase exposure to atorvastatin, raising myopathy and rhabdomyolysis risk. The patient has additional risk factors, including high-dose statin use, CKD and previous myalgia. The prescriber should consider withholding atorvastatin temporarily or using a non-interacting antibiotic where appropriate. Switching to simvastatin would worsen the interaction risk.

Reference: BNF