American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which of the following medications is known to interact with statins?

Warfarin
Diltiazem
Omeprazole
Levothyroxine

The correct answer is: Diltiazem

Diltiazem is known to interact with statins primarily due to its inhibitory effect on hepatic enzymes, particularly the cytochrome P450 3A4 (CYP3A4) pathway. Many statins, including atorvastatin, simvastatin, and lovastatin, are metabolized by this enzyme. When diltiazem is co-administered with these statins, it can increase their plasma concentrations, which in turn raises the risk of statin-related side effects, such as myopathy or rhabdomyolysis. The other options listed do not have the same level of interaction with statins. Warfarin, while it has its own interactions, does not significantly alter statin metabolism in a way that is clinically relevant for managing patients. Omeprazole, a proton pump inhibitor, has minimal effects on statin metabolism and is often considered safe to use with statins. Levothyroxine, a thyroid hormone replacement, does not have a known interaction with statins and is commonly used in patients on statin therapy without significant risk of altering statin efficacy. This makes diltiazem the most pertinent medication in terms of significant interaction with statins.