Durg interact question

  My Doctor has perscribed gembibrozil of 600 mg a day (for triglycerides) and 40 mg of Zocor for high cholestral. I recently took Pravachol of first 20 and then 40 mg a day for about 6 months, but the drug had no effect on my cholestral levels. So the switch to Zocor. When filling my prescription today, a drug interact warning was triggered (an identical warning was generated when I first picked up my Pravachol). At that time my doctor told me not to worry about the warning (and gave me a explanation I cannot recall). I have been monitored closely while on Pravachol, with no problems. Today the Pharmicist (a new person) said that he knew of no doctors who prescribe these class of drugs together (saying they are on the top-ten danger list). Could you please comment.Thank you.

[CCF CARDIO MD APS]

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Dear Greg,
For those patients with both LDL-cholesterol and triglyceride elevations, it is often necessary to use a triglyceride lowering drug such as gemfibrozil or niacin in addition to a statin (zocor is one of many FDA approved statins.)
The addition of gemfibrozil or niacin to the statin therapy does increase the risk of myopathy, however Greg it does not guarentee it; in other words, this drug combination might be on the "top ten watch out list" but it is not on the "top ten of do not prescribe together list."
You will have regular follow-up to check your liver enzymes on the statin (zocor) and on any symptoms  that would suggest  a myopathy and the need to stop the drug(s).  Meanwhile this combination is indicated and given the potential benefits, is worth the small risk that you take in combining the drugs.  It really would be best for you to discuss how you feel about this with your doctor, as well you can ask him/her how they plan on following up with lab work and or office visits.
Just so that you know, other drugs like Ketoconazole, itraconazole (antifungals), cyclosporin, and digoxin are all potentially dangerous in terms of potential interaction with the combination you are already on, so do not take any new drugs with first consulting the doctor who has you on the zocor and gemfibrozil.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
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