hi everyone this lesson is on what to
avoid if you are taking statin
medication so we're going to talk about
certain foods and beverages and
medications you want to avoid if you're
taking statins because they
may increase your risk for getting
statin side effects
we're also going to talk about some
supplements that you may want to try
that may help reduce the risk of side
effects from statin medications
let's first briefly talk about what
statin medications are and then we're
going to get into
some of those things you want to avoid
so statins are medications used to lower
or reduce blood cholesterol levels and
they all have the suffix statin so we
can think of a torvastatin or a suvastan
simvastatin and they inhibit synthesis
of cholesterol via inhibition of hmg-coa
reductase enzyme
and they may cause a variety of mild and
or severe side effects as we mentioned
previously in two other lessons if you
want more information on those side
effects please check out those
lessons and there are certain patient
characteristics that increase the risk
of having side effects these include
being
female being older so anybody greater
than the age of 80
is at an increased risk medical
condition so if a patient has medical
conditions like kidney disease liver
disease
or hypothyroidism which is a low thyroid
functioning
they all increase the risk for getting
statin side effects so it's important to
check
liver and kidney health and thyroid
functioning and then also having a
smaller body habitus so
being thinner is also another risk
factor for getting statin side effects
now the topic of this lesson is that
there are other factors
including some things that you eat and
drink that increase or decrease the risk
of statin side effects
so that is what we're going to talk
about in this lesson so
first we're going to talk about what
increases the risk of statin side
effects
so the first one is alcohol so statins
can cause hepatitis or liver
inflammation and liver damage
so we've talked about this in previous
lessons but statins can lead to
liver inflammation and damage and
drinking alcohol especially heavy
alcohol consumption
can exacerbate this liver inflammation
in liver damage
so although it might not increase the
risk of statin side effects
it will be an additive effect on the
liver so it's better to avoid
alcohol consumption because statins and
alcohol can both lead to liver
inflammation in
liver damage so it's again best to avoid
or at least
limit alcohol consumption when you are
taking statins
now an important food to avoid when
you're eating statins is grapefruit
so consuming grapefruits and or
consuming grapefruit juice is something
that you want to avoid if you are taking
statins the reason being is because
grapefruit inhibits the metabolism of
many
medications it inhibits certain enzymes
in the liver and these enzymes are
responsible for metabolizing many
medications including statins which can
lead to higher serum levels of statins
so because of this there's going to be a
higher level of statins than there
should be
and that higher level is going to lead
to increased risk of side effects
so it's important to avoid eating
grapefruit and avoid
drinking grapefruit juice now there are
certain medications that can lead to
increased risk of side effects from
statins these include other cholesterol
lowering medications
so other cholesterol lowering
medications if you are taking this along
with statins this can lead to an
increased risk for
side effects from statins and they
increase the effects of each other
in an example of these other cholesterol
lowering medications
are fibrates so phenofibrate is one
example
taking antibiotics can also lead to
increased levels of statins and
increased
risk of side effects from statins so
particular antibiotics that do this
include the macrolide antibiotics so
azithromycin and erythromycin
when used with a patient who is on
statins
appears to increase side effects and
mortality so it's very important for
your
primary care provider to think about
this when prescribing these medications
macrolides appear to inhibit p450 enzyme
which is an enzyme in your liver that is
responsible for metabolizing statins
essentially again leading to higher
statin serum levels so similar to the
mechanism of grapefruit
macrolides also inhibit the metabolism
of statins
leading to higher statin levels
antifungals are another class of
medications that can lead to increased
risk of statin side effects
so anti-fungals like the azole
medication so these medications have
azole at the end of their name
they can inhibit or impair liver enzymes
that metabolize a variety of medications
including statins
so again these easel medications so
fluconazole is one of them if you're
taking that it can inhibit enzymes in
your liver that metabolize
statins leading to increased levels of
statins in your blood
in increased risk of statin side effects
so again an example is fluconazole or
ketoconazole is another example
warfarin is also another medication that
can interact with statins
so warfarin is a vitamin k antagonist
used to decrease
the risk of blood clotting and most
statin medications appear to interact
with warfarin
through warfarin's ability to inhibit
cyp3a4
metabolism so again this is a very
important
cytochrome p450 enzyme that metabolizes
the statins
so it's cyp3a4 and again most statins
are
metabolized by this enzyme however from
studies it appears that atorvastatin
is the exception here and likely does
not interact with warfarin
heart medications can also lead to an
increased risk of statin side effects
so some heart medications which we'll
talk about here in a moment
lead to increased levels of statins
through various mechanisms efflux
transporters
and decreased statin metabolism and some
of these examples include
amiodarone varapamil and deltiazam
so again as you can see there's a lot of
similar
things going on here with all these
medications a lot of them
lead to inhibition of metabolism of the
statins leading to higher levels of
statins
and this is the reason why we see an
increased risk for statin side effects
cyclist born is another medication that
can lead to an increased risk for statin
side effects
cyclosporine is used in treatment of
some cases of rheumatoid arthritis in
psoriasis
and again cyclosporine inhibits cyp3a4
enzyme leading to decreased metabolism
of statins
again statin levels increase because of
this so you can see a lot of these
medications are inhibiting that cyp3a4
enzyme
and in particular what has been found
with cyclosporn
more specifically is that using
cyclosporine with statins increases the
risk of myopathy and rhabdomyolysis or
degradation or breakdown of muscle
and then because of all of this it's not
surprising that polypharmacy which is
just taking
a lot of different medications increases
your risk for statin side effects
so we talked a lot about different
medications that can inhibit the
metabolism of statins but there are many
others that could
also even slightly decrease the
metabolism and if there's
multiple medications that can lead to an
additive effect so polypharmacy again is
taking many prescription medications
and this may also occur with other
medications including over-the-counter
medications and herbal medications
so if you're taking a lot of
prescription medications over the
counter medications herbal medications
they can all interact they can all
cause inhibition on some of those
enzymes in the liver that
metabolize statins so again
this is all likely due to increasing
possibilities of
drug interactions one medication
decreasing or inhibiting the metabolism
of stat medications
so the more medications that are used
together
the more risk there is for one of these
medications
to inhibit statin metabolism
so this is why polypharmacy or taking
many prescription medications and many
other medications can lead to increased
risk of statin side effects
let's talk about some supplements that
may actually decrease the risk of statin
side effects
so one of them is coenzyme q10 this
comes from the review article entitled
does coenzyme q10 supplementation
mitigate statin associated muscle
symptoms
pharmacological and methodological
considerations
so it has been noted that statin
medications can lead to lower serum
levels of coenzyme q10
and coenzyme q10 is known to be
important for mitochondrial functioning
so it is possible that decreased
coenzyme q10
levels may be the possible cause of
statin-induced myopathy
so myopathy again is that a in pain in
the muscles
and even rhabdomyolysis which is that
breakdown or degradation of muscles that
can subsequently lead to
kidney injury and kidney failure now the
evidence here is mixed
some studies suggest that coenzyme q10
supplementation may help some studies
don't seem to find that relationship but
it could
so supplementing coenzyme q10 with
statin medications may
help reduce the risk of statin side
effects especially statin-induced
myopathy in rhabdomyolysis
and then another important supplement to
take if you're on stat medications is
vitamin d
and this comes from the article entitled
vitamin d serum levels in patients with
statin-induced
musculoskeletal pain so it has been
found that insufficient and or deficient
vitamin d levels are associated with an
increased risk for statin-induced
myopathy and rhabdomyolysis
so it's important that vitamin d
supplementation be taken
if patients are taking statins because
if they are deficient
they're at an even higher risk for
getting statin induced myopathy and
rhabdomyolysis so vitamin d
supplementation is very important
and there are certain lifestyle
modifications that can also be employed
to help reduce the risk of statins one
is avoiding or limiting
rigorous exercise the reason being is
because rigorous exercise especially
very rigorous exercise can increase the
risk for radomyolysis
and if statins are already increasing
the risk
of muscle injury and rhabdomy license is
better to avoid or limit
rigorous exercise and it's also
important to limit the number of
over-the-counter and herbal medications
so we talked about this before if there
is polypharmacy
so taking a lot of medications this is
going to increase your risk for
statins side effects because their
chances that one of those
is inhibiting statin metabolism becomes
higher and higher
the more medications and herbal
medications you're taking so
if possible it's best to try to limit
the number of over-the-counter and
herbal medications
so if you want to learn more about
statin side effects please check out my
lessons on those topics
and if you haven't already please like
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