Statin-macrolide combination ‘doubles risk of kidney injury’

GPs should avoid prescribing macrolide antibiotics with statins ‘where possible’ as the combination doubles the risk of acute kidney injury, finds a new study.
The Canadian researchers found the risk of all-cause mortality was one and a half times higher in patients taking macrolides and statins, compared with those taking azithromycin and a statin.
Writing in the Annals of Internal Medicine, they said that this was the first study to quantify the risks of the interaction between statins and macrolides.
They also said that many deaths and hospitalisations with acute kidney injury ‘may have been attributable to this interaction’.
But GP leaders said that the overall risk to patients was low and that it reinforced current advice that patients should not take the drugs together.
The study – published this week – examined statistics from four Ontario health databases on prescribing, hospitalisation and illness among 144,000 statin users aged over 65 who were co-prescribed antibiotics during 2003 to 2010.
Some 73,000 patients were also taking clarithromycin, 3,300 erythromycin and 68,000 azithromycin, which was used as the comparator.
The British National Formulary current advises that there is ‘an increased incidence of myopathy if a statin is given … with drugs that increase the plasma-statin concentration, such as macrolide antibiotics’.
This study found the risk of hospitalisation with rhabdomyolysis within 30 days was more than twice as high among patients taking statins and macrolides, compared with those taking a statin and azithromycin, 0.03% versus 0.01% respectively.
They also found a greater risk of acute kidney injury, with 0.46% of patients taking statins and macrolides diagnosed with the complication, compared with 0.26% taking a statin and azithromycin.
The risk of all-cause mortality was also one and a half times higher in the statin/macrolide patients, compard with those taking a statin and azithromycin.

More on this Pulse story here.


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