Potential statin drug interactions in elderly patients: a review

ABSTRACT

Introduction

Persons aged more than 65 years may be more prone to suffer from chronic diseases and comorbidities (as demonstrated by the recent COVID-19 pandemics) and are treated with multiple concomitant medications. This may result in drug-drug interactions (DDIs) that are often overlooked in clinical practice. Elderly patients are more affected by comorbidities increasing the risk of DDIs and adverse drug reactions (ADRs). Statins are effective in elderly patients with or at risk for cardiovascular disease (CVD) and are prescribed on a long-term basis and may undergo DDIs, particularly on pharmacokinetic bases. The risk of DDIs varies among statins, and safety and ADRs of statins are of special concern in patients affected by multiple chronic conditions requiring concomitant therapies at risk of DDIs, such as the elderly.

Areas covered

The purpose of this manuscript is to give an update on the potential statin DDIs and related ADRs with an exclusive focus on the data available in elderly patients.

Expert opinion

A better and more close attention to the potential DDIs among statins and other therapeutic options will help physicians in selecting the more effective and less harmful treatment for their patients. This is of importance, especially in older patients.

KEYWORDS:

• Aging
• COVID-19
• HIV patients
• monoclonal antibodies
• sacubitril
• statin pharmacokinetics
• tocilizumab

Article highlights

• Aging does not affect the clinical efficacy of drugs, but elderly people suffer from chronic diseases and comorbidities and are the major consumers of drugs thus increasing the potential risk of drug-drug interactions (DDIs).

• The prevalence of inappropriate drug use in the elderly ranges between 11.5% and 62.5%, and drug side-effects are seven times more frequent in the elderly than in younger patients.

• The safety and adverse effects of statins are of special concern especially in patients affected by multiple chronic conditions requiring concomitant therapies at risk of DDIs such as the elderly.

• Clinically relevant potential pharmacokinetic DDIs with statins have been identified in patients more than 75 years old that were receiving up to 6 concomitant medications and represented about one third of all potential DDIs. Among these patients, more than 70% were co-treated with a CYP3A4 inhibitor and suffered of potentially harmful statin DDIs.

• Differences in pharmacokinetic profiles of the different statins may influence their adverse effect profile. Caution should be taken to balance the potential clinical benefits versus the risks when co-administering drugs in elderly patients receiving statin therapy.

• Only a better and more profound knowledge of the potential DDIs among statins and other therapeutic options will help physicians in selecting the more effective and less harmful treatment for their patients, even considering a careful reduction of drug burden.

Declaration of interest

A Corsini has received research grants and/or honoraria from or having been a consultant for Astra Zeneca, Merck and Co, Pfizer Inc., Kowa, Recordati, AMGEM, Sanofi Aventis.

S Bellosta received an honorarium from Novartis for giving a lecture. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded