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Drug Interactions between mibefradil and pravastatin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

pravastatin mibefradil

Applies to: pravastatin and mibefradil

CONTRAINDICATED: Rhabdomyolysis has been reported in patients receiving mibefradil and simvastatin. In vitro studies predict that mibefradil inhibits the metabolism of drugs that are substrates of the CYP450 microsomal pathway. HMG-CoA reductase inhibitors are metabolized to varying degrees by this pathway.

MANAGEMENT: The use of mibefradil with simvastatin and lovastatin is considered contraindicated, while the use of mibefradil with cerivastatin or atorvastatin is strongly discouraged by the manufacturers. Fluvastatin and pravastatin may be the preferred alternatives if an HMG-CoA reductase inhibitor must be used with mibefradil, since they are not significantly metabolized by the CYP450 pathway. Consideration should also be given to alternative antihypertensive therapy. However, if these agents must be used together, close observation for evidence of altered clinical effect is recommended. Additionally, the use of any HMG-CoA reductase inhibitor is not recommended in combination with mibefradil and either cyclosporine or tacrolimus, since additive inhibition of the metabolism of the HMG-CoA reductase inhibitor would be expected.

References (4)
  1. (2001) "Product Information. Posicor (mibefradil)." Roche Laboratories
  2. Muck W (2000) "Metabolic interactions between mibefradil and HMG-CoA reductase inhibitors: linking in vitro with in vivo information." Br J Clin Pharmacol, 49, p. 87-90
  3. Schmassmann-Suhijar D, Bullingham R, Gasser R, Schmutz J, Haefeli WE (1998) "Rhabdomyolysis due to interaction of simvastatin with mibefradil." Lancet, 351, p. 1929-30
  4. Holtzman CW, Wiggins BS, Spinler SA (2006) "Role of P-glycoprotein in statin drug interactions." Pharmacotherapy, 26, p. 1601-7

Drug and food interactions

Moderate

pravastatin food

Applies to: pravastatin

MONITOR: Concomitant use of statin medication with substantial quantities of alcohol may increase the risk of hepatic injury. Transient increases in serum transaminases have been reported with statin use and while these increases generally resolve or improve with continued therapy or a brief interruption in therapy, there have been rare postmarketing reports of fatal and non-fatal hepatic failure in patients taking statins. Patients who consume substantial quantities of alcohol and/or have a history of liver disease may be at increased risk for hepatic injury. Active liver disease or unexplained transaminase elevations are contraindications to statin use.

MANAGEMENT: Patients should be counseled to avoid substantial quantities of alcohol in combination with statin medications and clinicians should be aware of the increased risk for hepatotoxicity in these patients.

References (9)
  1. (2001) "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb
  2. (2001) "Product Information. Zocor (simvastatin)." Merck & Co., Inc
  3. (2001) "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals
  4. (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
  5. (2002) "Product Information. Altocor (lovastatin)." Andrx Pharmaceuticals
  6. (2003) "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  8. Cerner Multum, Inc. "Australian Product Information."
  9. (2010) "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic)

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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