Musculoskeletal Adverse Events Associated with Simvastatin Drug Interactions and Physician Response to Pharmacist Interventions
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Abstract
Introduction: Myopathy is the major adverse events which can be found with statins use. The statin-drug interaction is one of the important risk factor associated with musculoskeletal adverse events. Although simvastatin is mostly prescribed in Thailand, studies investigating the prevalence of musculoskeletal adverse events associated with simvastatin drug interactions is still limited. Objective: This study aims to investigate the prevalence of musculoskeletal adverse effect which is associated with simvastatin-drug interactions. In addition, we evaluated the physician response to pharmacist intervention regarding to potential simvastatin-drug interaction. Methods: Outpatients who had prescriptions containing potential simvastatin-drug interaction were recruited. This cross-sectional study was conducted between October 1, 2013 and February 28, 2014 at Piboonmungsaharn Hospital, Ubonratchathanee Province. The musculoskeletal adverse events were evaluated by using symptom checklist questionnaires and measuring plasma creatinine kinase (CK). The causal relationship between the adverse events and the potential simvastatin-drug interactions was assessed using the Drug Interaction Probability Scale (DIPS). Results: The potential simvastatin-drug interactions were found in 49 patients. Of these, we found 31 patients (63.3%) had myopathy. Myalgia was the most frequently identified adverse events (58.1%), followed by asymptomatic raising CK (25.8%), and myositis (16.1%). Musculoskeletal adverse events associated with simvastatin-drug interactions were found in 16 patients (51.6%). Of these, we found 50.0%, 31.3% and 18.8% had asymptomatic raising CK, myalgia, and myositis, respectively. The precipitant drugs associated with myopathy that mostly prescribed with simvastatin were gemfibrozil, colchicine and amlodipine. According to pharmacist interventions to physicians about simvastatin-drug interactions, the acceptance rate was 83.7% and the prescriptions were changed in 49.0%. Conclusion: Musculoskeletal adverse events with simvastatin use were found in Thai patients, and approximately half of them was associated simvastatin-drug interactions. Data suggested that the systems can be utilized by healthcare professionals are needed to increase awareness of potential simvastatin-drug interactions.
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