Which statin can be given with verapamil or diltiazem?

The correct choice is flavastatin due to its pharmacological profile and metabolism, which allows for co-administration with calcium channel blockers like verapamil or diltiazem. Fluvastatin is primarily metabolized by the liver enzyme CYP2C9 and demonstrates a more favorable interaction with these medications, leading to a reduced risk of significant drug-drug interactions.

When it comes to statins in general, they have varying potentials for interaction with other drugs based on their metabolic pathways. For example, simvastatin and lovastatin are more reliant on CYP3A4 for their metabolism, and since verapamil and diltiazem are also metabolized by this enzyme, this can lead to increased serum levels and associated side effects when these drugs are taken together. By contrast, fluvastatin's metabolism does not heavily involve CYP3A4, making it a safer choice to use concurrently with calcium channel blockers that influence this enzyme's activity.

This understanding of statin metabolism and interactions is crucial for managing patients on these medications, particularly for avoiding adverse effects and ensuring optimal therapeutic outcomes.