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To the Editor: Dr Thompson and colleagues¹ reported that 7% of cases of statin-induced rhabdomyolysis in the US Food and Drug Administration (FDA) Qscan database from November 1997 through March 2000 were associated with a coprescription for macrolide antibiotics. Such coprescriptions, however, only accounted for 3% of such incidents between January 1990 and March 2002. It is unclear whether this represents a class effect or is due only to specific macrolide antibiotics.

Because the 3 most commonly prescribed macrolides differ from one another in their effects on the cytochrome system,² there may not be single macrolide class effect for the risk of statin-associated rhabdomyolysis. Erythromycin, a group 1 agent, strongly binds and inhibits cytochrome P-450 (CYP) 3A4. Clarithromycin is a group 2 agent and exhibits less affinity for CYP 3A4 than does erythromycin. Group 3 agents include azithromycin, which has been found to have little interference with the CYP system.² . . . [Full Text of this Article]

Join Y. Luh, MD
Departments of Surgery and Internal Medicine

Bernard M. Karnath, MD
Department of Internal Medicine
University of Texas Medical Branch at Galveston