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Question 456
Pharmacology → General
Classification
Question
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A patient with hyperlipidaemia is receiving a statin. Addition of a second lipid-lowering drug is being considered. Which combination is specifically associated with an increased risk of myositis?
Question Stem
Select the single best answer.
Options
A
Statin with a fibrate
B
Statin with metronidazole
C
Statin with sildenafil
D
Statin with phenytoin
E
Statin with cimetidine
Explanation
Statin therapy may sometimes be combined with fibrates in hyperlipidaemia, but this combination is associated with an increased risk of myositis. This differs from the profound hypotension described with sildenafil plus isosorbide mononitrate and the disulfiram-like reaction described with metronidazole plus alcohol.
Option Validity
B) Statin plus metronidazole is not the combination associated with the increased myositis risk described here.
C) Sildenafil combined with isosorbide mononitrate, producing profound hypotension rather than myositis.
D) Phenytoin is a hepatic microsomal enzyme inducer; statin plus fibrate is the relevant combination associated with increased myositis risk.
E) Cimetidine is an enzyme inhibitor, not as the lipid-lowering combination associated with myositis.
Further Reading
Saxena R. Textbook for MRCOG-1. Chapter 12: Pharmacology. Clinical Pharmacy, pp.344–345.