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The combination of a fibric acid derivative (fibrate) and a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) may offer a therapeutic advantage to patients with combined hyperlipidemia who respond inadequately to either agent alone. However, physicians remain reluctant to prescribe statins and fibrates concomitantly because of their concern that drug-drug interactions will increase the probability of muscle damage. Fibrates have been shown to increase statin plasma concentrations and to be associated with an increased risk of severe myopathy and rhabdomyolysis when prescribed in combination with a statin.^1-2 The question of whether the increase in risk is due to a class effect for all fibrate-statin combinations remains unanswered.

In our review of the risk of myopathy with statin therapy, we presented information on fibrate-statin interactions.³ At the time of the writing of this article, several studies had shown that gemfibrozil use increases plasma concentration of statins.⁴ In contrast, use of fenofibrate—another . . . [Full Text of this Article]

Christie M. Ballantyne, MD
Houston, Tex

Michael H. Davidson, MD
Chicago, Ill

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