Clarification to a previous issue
The “Test yourself” item from the Oct. 4 ACP InternistWeekly needs clarification.
In the Oct. 4 issue of ACP InternistWeekly, the “Test yourself” question involved initiation of statin treatment in a diabetic and hypertensive patient currently being treated with amlodipine. The correct answer was treatment with simvastatin, with the critique section noting that up to 40 mg daily might be needed to achieve adequate LDL reduction.
In June 2011, the FDA issued new guidelines indicating that simvastatin dosing in patients taking amlodipine should not exceed 20 mg daily due to a drug-drug interaction and an increased risk of rhabdomyolysis. If simvastatin is selected in this case, it should be limited to 20 mg daily or less with appropriate monitoring of clinical and laboratory parameters. Other statins are not known to have a clear interaction with amlodipine and would be reasonable alternatives in this patient.
The original item has been corrected.