Doctors and patients need to be aware of drug-drug interactions between medications used to lower cholesterol and those used to treat heart disease, according to new recommendations from the American Heart Association (AHA).
Statins, which are used to lower cholesterol, are among the most popular drugs prescribed to American adults. They are also prescribed to patients who have clogged arteries, a condition known as atherosclerosis, or those at risk for it. In many cases, these people are also taking other heart meds.
The AHA published a list of drugs often given to heart patients that can often interact with statins. These include:
- Blood pressure-lowering medications known as calcium channel blockers. These include Norvasc (amlodipine), Cardizem (diltiazem) and Calan (verapamil).
- Drugs to treat irregular heartbeat, such as Multaq (dronedarone), Cordarone (amiodarone) and Digox (digoxin)
- Heart failure medications, including Entresto (sacubitril/valsartan) and Corlanor (ivabradine)
- Drugs known as fibrates which are used to lower triglycerides, another type of lipid (fat) in the blood, such as Lopid (gemfibrozil)
- Blood thinners, such as Coumadin (warfarin) and Brilinta (ticagrelor)
The most common interaction when taking these drugs in combination with a statin is that it can increase the level of the statin in the blood, which can lead to muscle weakness or pain. However, the benefits of taking the medications outweigh the risks, which are relatively minor, the recommendations state. To minimize the risks, a doctor should adjust the dose of the statin.
But there are some drug combinations that should be avoided. For example, Lopid should never been taken with the statins Mevachol (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin).
In other instances, the AHA recommends limiting the dose of a statin when taken together with another heart drug. People who take Norvasc should be limited to 20 mg a day or less of Mevachol or Zocor. Patients on Cordarone should take, at most, 20 mg a day of Zocor or 40 mg a day of Mevachol. Zocor should also be limited to 10 mg a day when given in combination with Multaq.