From the Guidelines
When taking fluconazole with statins, it's recommended to hold the statin medication for the duration of fluconazole treatment plus an additional 1-2 days after completing the antifungal course. This recommendation is crucial due to the interaction between fluconazole and statins metabolized through the CYP3A4 pathway, such as atorvastatin, simvastatin, and lovastatin, as noted in general clinical guidelines 1. The key points to consider are:
- Fluconazole inhibits the CYP3A4 enzyme system, potentially causing statin levels to increase in the bloodstream.
- This interaction increases the risk of statin-related side effects, including muscle pain, weakness, and in severe cases, rhabdomyolysis.
- For short courses of fluconazole, a brief statin interruption of 1-3 days may be sufficient.
- For longer antifungal treatments, the statin should remain held until fluconazole is cleared from the system.
- Statins like rosuvastatin and pravastatin are less affected by this interaction and might be considered as alternatives if statin therapy must be continued during fluconazole treatment, though dose reduction may still be prudent. It's essential to monitor patients closely for any signs of statin toxicity when restarting the medication after fluconazole treatment, as advised in the management of statin therapy 1.
From the Research
Statin and Fluconazole Interaction
- The interaction between statins and fluconazole can increase the risk of myopathy or rhabdomyolysis 2, 3.
- Fluconazole is a CYP3A4 inhibitor, which can increase the levels of statins in the body, leading to increased risk of toxicity 3.
- There is no specific recommendation on the number of days to hold statin when on fluconazole, but it is recommended to monitor patients closely for drug interactions and adjust the statin dose or discontinue it if necessary 2, 3.
- In one study, physicians were informed about the co-prescription of CYP3A4 inhibitors with simvastatin or atorvastatin, and the prescription was subsequently changed in 59.5% of cases 3.
- The risk of myotoxicity due to statins can be minimized through interdisciplinary co-operation between pharmacists and physicians 3.