Statins are commonly used in patients with hyperlipidemia and atherosclerosis, and their clinical application is gradually expanding with deeper understanding, but their common adverse reactions such as myalgia and elevated liver enzymes are also a problem that should not be ignored in the long-term use of drugs. In the process of clinical use of drugs, there are some adverse reactions related to personal constitution, while some adverse reactions occur or worsen with the combined application of drugs. Today we will briefly discuss some of the common drugs that may accentuate or exacerbate the adverse effects of statins. Drug metabolism process To understand the effects and adverse reactions of drugs, it is first necessary to briefly understand the metabolism process of drugs, because the metabolism process of drugs determines the clinical effects and adverse reactions of drugs. Drugs that are absorbed through the intestines are first metabolized by the liver. Some drugs lose some of their “activity” during this process, while others are “processed” to produce components that actually work. The process of hepatic metabolism reduces the adverse effects of most drugs. Because the liver is such a chemical factory for the metabolism of various chemicals, there are different “assembly lines” in the chemical factory, such as the cytochrome CYP450 family, and therefore the liver bears a huge amount of “work pressure”, and most statins are mainly metabolized by the liver. Metabolism. When different drugs are processed in the same assembly line and the workload becomes excessive, this can lead to disruption of the factory, resulting in liver dysfunction, rhabdomyolysis, and other adverse effects. Drugs That May Increase the Risk of Statin Toxicity 1. Betaben Betaben is also a lipid-lowering drug, and interactions between statins and betaben are more common with gemfibrozil than with fenofibrate. However, even when combined with gemfibrozil, rhabdomyolysis occurs in less than 1% of patients when statins are combined with gemfibrozil. 2, Amiodarone This drug is more likely to interact with simvastatin and lovastatin. Its adverse effect is an increased risk of rhabdomyolysis. 3, azole antifungal agents All drugs in this class have the potential to increase the toxic effects of statins. The main reason is that this type of antifungal drugs can inhibit the activity of the corresponding liver enzymes and make the occurrence of rhabdomyolysis, the symptoms of myalgia may occur. 4, protease inhibitors The specific interaction mechanism is not clear, but may greatly increase the exposure of statin in the plasma, especially statin and ritonavir have significant interaction. 5.Calcium channel blockers For the common treatment of arrhythmia, angina pectoris and antihypertensive drugs, verapamil and diltiazem have significant interactions with statins, which can lead to an increase in statin blood concentrations and highlight their adverse effects. Amlodipine and nifedipine, while still posing some risk, cause less statin toxicity than other drugs in the class. 6, macrolide antibiotics with antifungal drugs, the same inhibition of the corresponding metabolism of statin drug enzyme system activity and cause statin drug blood concentration is too high and the emergence of rhabdomyolysis and other adverse reactions. The most pronounced interactions are erythromycin and clarithromycin. Other drugs in this class of antibiotics, such as azithromycin, are not known to increase the risk of statin toxicity. Summary Although the various statins have different chances of interaction with other drugs, but different statins have different characteristics, clinical need to be adjusted according to the characteristics of each patient’s condition, is not simply because of the different chances of interaction with other drugs and tend to choose or not to choose which one of the drugs, but when it is necessary to be used in conjunction with the above drugs, attention needs to be paid to the observation as well as monitoring of somatic symptoms and test indexes, in order to prevent adverse consequences. to prevent adverse consequences.