Detecting drug interactions from adverse-event reports: interaction between paroxetine and pravastatin increases blood glucose levels

Clin Pharmacol Ther. 2011 Jul;90(1):133-42. doi: 10.1038/clpt.2011.83. Epub 2011 May 25.

Abstract

The lipid-lowering agent pravastatin and the antidepressant paroxetine are among the most widely prescribed drugs in the world. Unexpected interactions between them could have important public health implications. We mined the US Food and Drug Administration's (FDA's) Adverse Event Reporting System (AERS) for side-effect profiles involving glucose homeostasis and found a surprisingly strong signal for comedication with pravastatin and paroxetine. We retrospectively evaluated changes in blood glucose in 104 patients with diabetes and 135 without diabetes who had received comedication with these two drugs, using data in electronic medical record (EMR) systems of three geographically distinct sites. We assessed the mean random blood glucose levels before and after treatment with the drugs. We found that pravastatin and paroxetine, when administered together, had a synergistic effect on blood glucose. The average increase was 19 mg/dl (1.0 mmol/l) overall, and in those with diabetes it was 48 mg/dl (2.7 mmol/l). In contrast, neither drug administered singly was associated with such changes in glucose levels. An increase in glucose levels is not a general effect of combined therapy with selective serotonin reuptake inhibitors (SSRIs) and statins.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adverse Drug Reaction Reporting Systems*
  • Age Factors
  • Aged
  • Algorithms
  • Blood Glucose / metabolism*
  • Cohort Studies
  • Data Mining
  • Diabetes Mellitus / metabolism
  • Drug Interactions
  • Electronic Health Records
  • Ethnicity
  • Female
  • Homeostasis / drug effects
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Male
  • Middle Aged
  • Paroxetine / adverse effects*
  • Pravastatin / adverse effects*
  • Retrospective Studies
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Sex Factors
  • Socioeconomic Factors
  • United States
  • United States Food and Drug Administration

Substances

  • Blood Glucose
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Serotonin Uptake Inhibitors
  • Paroxetine
  • Pravastatin