Editing Statin (section)

===Drug interactions===
Combining any statin with a [[fibrate]] or [[Niacin (substance)|niacin]] (other categories of lipid-lowering drugs) increases the risks for [[rhabdomyolysis]] to almost 6.0 per 10,000 persons, per year.<ref name="Graham2004"/> Monitoring liver enzymes and creatine kinase is especially prudent in those on high-dose statins or in those on statin/fibrate combinations, and mandatory in the case of muscle cramps or of deterioration in [[kidney function]].<ref>{{Cite journal |last1=Newman |first1=Connie B. |last2=Preiss |first2=David |last3=Tobert |first3=Jonathan A. |last4=Jacobson |first4=Terry A. |last5=Page |first5=Robert L. |last6=Goldstein |first6=Larry B. |last7=Chin |first7=Clifford |last8=Tannock |first8=Lisa R. |last9=Miller |first9=Michael |last10=Raghuveer |first10=Geetha |last11=Duell |first11=P. Barton |last12=Brinton |first12=Eliot A. |last13=Pollak |first13=Amy |last14=Braun |first14=Lynne T. |last15=Welty |first15=Francine K. |year=2019 |title=Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association |url=https://www.ahajournals.org/doi/10.1161/ATV.0000000000000073 |journal=[[Arteriosclerosis, Thrombosis, and Vascular Biology]] |volume=39 |issue=2 |pages=e38–e81 |doi=10.1161/ATV.0000000000000073 |issn=1079-5642 |pmid=30580575 |access-date=14 May 2024 |archive-date=28 May 2024 |archive-url=https://web.archive.org/web/20240528015624/https://www.ahajournals.org/doi/10.1161/ATV.0000000000000073 |url-status=live }}</ref>

Consumption of [[grapefruit]] or [[grapefruit juice]] [[Grapefruit–drug interactions|inhibits]] the metabolism of certain statins, and [[bitter orange]]s may have a similar effect.<ref>[http://www.mayoclinic.com/health/food-and-nutrition/AN00413 Katherine Zeratsky, R.D., L.D., Mayo clinic: article on interference between grapefruit and medication] {{Webarchive|url=https://web.archive.org/web/20131029220210/http://www.mayoclinic.com/health/food-and-nutrition/AN00413 |date=29 October 2013 }} Accessed 1 May 2017</ref> Furanocoumarins in grapefruit juice (i.e. [[bergamottin]] and [[6',7'-dihydroxybergamottin|dihydroxybergamottin]]) inhibit the [[Cytochrome P450 oxidase|cytochrome P450]] enzyme [[CYP3A4]], which is involved in the metabolism of most statins (however, it is a major inhibitor of only lovastatin, simvastatin, and to a lesser degree, atorvastatin) and some other medications<ref name="Kane2000">{{cite journal | vauthors = Kane GC, Lipsky JJ | title = Drug-grapefruit juice interactions | journal = Mayo Clinic Proceedings | volume = 75 | issue = 9 | pages = 933–942 | date = September 2000 | pmid = 10994829 | doi = 10.4065/75.9.933 | doi-access = free | title-link = doi }}</ref> (flavonoids (i.e. [[naringin]]) were thought to be responsible). This increases the levels of the statin, increasing the risk of dose-related adverse effects (including [[myopathy]]/[[rhabdomyolysis]]). The absolute prohibition of grapefruit juice consumption for users of some statins is controversial.<ref name="pmid17695563">{{cite journal | vauthors = Reamy BV, Stephens MB | title = The grapefruit-drug interaction debate: role of statins | journal = American Family Physician | volume = 76 | issue = 2 | pages = 190, 192; author reply 192 | date = July 2007 | pmid = 17695563 | url = http://www.aafp.org/afp/2007/0715/p190.html | access-date = 29 April 2012 | archive-date = 10 November 2018 | archive-url = https://web.archive.org/web/20181110120130/https://www.aafp.org/afp/2007/0715/p190.html | url-status = live }}</ref>

The U.S. [[Food and Drug Administration]] (FDA) notified healthcare professionals of updates to the prescribing information concerning interactions between protease inhibitors and certain statin drugs. Protease inhibitors and statins taken together may increase the blood levels of statins and increase the risk for muscle injury (myopathy). The most serious form of myopathy, rhabdomyolysis, can damage the kidneys and lead to kidney failure, which can be fatal.<ref>{{cite web | title=Statins and HIV or Hepatitis C Drugs: Drug Safety Communication – Interaction Increases Risk of Muscle Injury | website=U.S. [[Food and Drug Administration]] (FDA) | date=1 March 2012 | url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm294294.htm | archive-url=https://web.archive.org/web/20170118091759/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm294294.htm | archive-date=18 January 2017 | access-date=12 October 2019}}</ref>