Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Święcickiego 6 St, 60-781, Poznań, Poland.
Drugs. 2018 Jul;78(11):1105-1112. doi: 10.1007/s40265-018-0947-x.
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 2018 are presented and discussed. In summary, co-administration of statins and ticagrelor was found to be relatively safe in routinely prescribed doses. However, caution should be exercised, especially in elder populations.
替格瑞洛的引入是首个直接作用的口服抗血小板药物之一，为急性冠脉综合征（ACS）患者预防血栓事件提供了新的可能。目前的指南建议 ACS 患者在双联抗血小板治疗中，将替格瑞洛与阿司匹林联合使用，以预防支架内血栓形成。此外，在 ACS 的管理中，建议使用高强度他汀类药物进行降脂治疗，以长期预防心血管事件的二次发生。尽管联合抗血小板和降脂治疗具有明显的优势，但他汀类药物与替格瑞洛之间可能存在相互作用，导致肌病和横纹肌溶解。在这篇综述中，收集了关于替格瑞洛与他汀类药物相互作用的相关信息，这种相互作用可能导致危及生命的情况。本综述重点介绍了最广泛使用的他汀类药物——辛伐他汀、阿托伐他汀和瑞舒伐他汀。讨论了这种相互作用的可能机制，包括 CYP3A4 同工酶、有机阴离子转运多肽（OATPs）、P-糖蛋白和葡萄糖醛酸化。在 PubMed 数据库中搜索了相关的病例报告，并介绍和讨论了从替格瑞洛引入到 2018 年 3 月期间收集到的所有数据。总之，在常规剂量下，他汀类药物与替格瑞洛联合使用相对安全。但是，应谨慎使用，尤其是在老年人群中。
