Short report
Efficacy of statin therapy: possible effect of phenytoin
M J Murphy, M H Dominiczak
Department of
Biochemistry, Gartnavel General Hospital, 1053 Great Western Road,
Glasgow G12 0YN, UK
Correspondence to: M J Murphy, Derriford Combined Laboratory, Derriford Hospital, Plymouth PL6 8DH, Devon, UK
Accepted 7 December
1998
Statins are currently the most widely prescribed lipid-lowering
drugs. Individual statins are known to be metabolised by the CYP3A4
isoform of the cytochrome P450 system. The effect of CYP3A4 inducers
such as phenytoin on the metabolism and efficacy of these agents is
unknown. We report a patient with familial hypercholesterolaemia and
epilepsy in whom the introduction and subsequent discontinuation of
phenytoin were associated with marked changes in the lipid response to
treatment with simvastatin and atorvastatin. The serum activity of
-glutamyl transpeptidase may have acted as a marker of microsomal
induction by phenytoin, since it rose markedly when phenytoin was
introduced and returned to normal after it was discontinued.
Keywords: statins; phenytoin; drug interaction
© 1999 by The Fellowship of Postgraduate Medicine
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