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Atorvastatin and Promacta

Determining the interaction of Atorvastatin and Promacta and the possibility of their joint administration.

Check result:
Atorvastatin <> Promacta
Relevance: 18.08.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Eltrombopag may increase the blood levels of atorvastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. In some cases, rhabdomyolysis can cause kidney damage and even death. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the interaction, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness while taking these medications, especially if these symptoms are accompanied by fever or dark colored urine. You should also seek immediate medical attention if you develop fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

ADJUST DOSE: Coadministration with eltrombopag may increase the plasma concentrations of HMG-CoA reductase inhibitors (statins). The proposed mechanism is decreased clearance due to eltrombopag inhibition of the OATP 1B1-mediated hepatic uptake of statins and/or their metabolites (e.g., simvastatin acid), with fluvastatin the least likely to be significantly affected. In 39 healthy adult subjects given eltrombopag 75 mg once daily for 4 days prior to coadministration with a single 10 mg dose of rosuvastatin on day 5, mean rosuvastatin peak plasma concentration (Cmax) increased by 103% and systemic exposure (AUC) by 55%. High levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.

MANAGEMENT: Lower statin dosages should be considered during coadministration with eltrombopag. In clinical trials with eltrombopag, a dosage reduction of rosuvastatin by 50% was recommended. No specific adjustment recommendations were given for the others. All patients receiving statin therapy should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.

References
  • Canadian Pharmacists Association "e-CPS. Available from: URL: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink."
  • Allred AJ, Bowen CJ, Park JW, et al. "Eltrombopag increases plasma rosuvastatin exposure in healthy volunteers." Br J Clin Pharmacol 72 (2011): 321-9
  • Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  • Cerner Multum, Inc. "Australian Product Information." O 0
  • Kalliokoski A, Niemi M "Impact of OATP transporters on pharmacokinetics." Br J Pharmacol 158 (2009): 693-705
  • "Product Information. Promacta (eltrombopag)." GlaxoSmithKline, Research Triangle Park, NC.
Atorvastatin

Generic Name: atorvastatin

Brand name: Lipitor

Synonyms: AtorvaSTATin

Promacta

Generic Name: eltrombopag

Brand name: Promacta

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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