American Board of Family Medicine (ABFM) Practice Exam

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Which medication is contraindicated in patients taking statins?

Amoxicillin/clavulanate
Azithromycin
Clarithromycin
Doxycycline

The correct answer is: Clarithromycin

Clarithromycin is contraindicated in patients taking statins primarily due to its potential to significantly inhibit the metabolism of statins, leading to increased levels of statins in the blood. This can elevate the risk of statin-related side effects, particularly myopathy or rhabdomyolysis, which are serious conditions that can occur when statin levels become too high. Clarithromycin is a potent inhibitor of the cytochrome P450 3A4 enzyme, which is involved in the metabolism of many statins, particularly atorvastatin, simvastatin, and lovastatin. When combined, clarithromycin can increase the plasma concentration of these statins, heightening the likelihood of adverse effects. In contrast, the other medications listed, such as amoxicillin/clavulanate, azithromycin, and doxycycline, do not have the same level of interaction with the metabolic pathways of statins, making them safer alternatives for use in patients who are being treated with statins. Therefore, while clarithromycin poses a significant risk, the others do not have the same contraindications.