FA 2017: Fibrate ADRs include myopathy increased risk with statins, cholesterol gallstones

this patient began rosuvastatin tx 4 weeks ago.

rosuvastatin, pitavastatin, pravastatin are substrates for the organic anion transporting polypeptide (OATP). however, none of these 3 statins are substrates of CYP3A4.

OATP transports the statin from the plasma into the hepatocyte. The statin can then be metabolized by hepatic enzymes or transported into the bile for elimination via the gastrointestinal tract.

Interference with OATP activity results in accumulation of statin in the plasma and may lead to myopathy.

FA 2019, 315 pg

https://www.pharmacytimes.com/publications/issue/2014/June2014/Statins-and-OATP-Interactions

statin + fibrate = myopathy. possibly most HY pharm principle tested