Assessment of the Risk of Rhabdomyolysis and Myopathy During Concomitant Treatment with Ticagrelor and Statins

Drugs
Dorota DanielakFranciszek Główka

Abstract

The introduction of ticagrelor, one of the first directly-acting oral antiplatelet drugs, provided new possibilities in the prevention of thrombotic events in patients with acute coronary syndromes (ACS). Current guidelines recommend ticagrelor in dual antiplatelet therapy with aspirin over clopidogrel for prevention of stent thrombosis in patients with ACS. Moreover, in the management of ACS, lipid-lowering treatment with high-intensity statin therapy is advised for secondary prevention of cardiovascular events over the long term. Despite the apparent advantages of combined antiplatelet and lipid-lowering treatments, a possible interaction between statins and ticagrelor may lead to myopathy and rhabdomyolysis. In this review, relevant information was gathered on the ticagrelor-statin interaction that might lead to this life-threatening condition. This review focuses on the most widely used statins-simvastatin, atorvastatin, and rosuvastatin. Possible mechanisms of this interaction are discussed, including CYP3A4 isoenzymes, organic anion transporter polypeptide (OATPs), P-glycoprotein and glucuronidation. PubMed database was searched for relevant case reports and all data gathered from the introduction of ticagrelor to March 2...Continue Reading

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Citations

Mar 28, 2019·Expert Review of Clinical Pharmacology·Ramón CacabelosJuan C Carril
Aug 8, 2019·Drug Development Research·Mohammad S HareedyMarwa F Ali
Apr 24, 2021·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Songyu LiuJunzhi Lin
Jun 15, 2021·Saudi Journal of Biological Sciences·Mohammed AsadRaha Orfali
Oct 26, 2021·The Nurse Practitioner·Luke P ParishBenjamin Duhart
Oct 29, 2021·Internal Medicine·Shohei ObayashiYoko Ito

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