Recent experience with troglitazone is relevant. Despite increasing reports of acute liver failure and four successive warning letters from the Food and Drug Administration, by the time of its withdrawal from the market the drug had been linked to 43 cases of liver failure.
Pravastatin and rosuvastatin are hydrophilic statins that are eliminated by the kidney. They are not metabolized by the P-450 pathway which may render them relatively safer components of the statin armamentarium when agents that are metabolized by P-450 are administered simultaneously.
B. Beta-Adrenergic Blocking Agents
Beta-blockers are cardioactive agents commonly used in the management of angina, heart attacks, hypertension, arrhythmias, and heart failure. These agents have been used worldwide since 1969. Interactions are, however, few. A single P-450 can oxidize a large number of drugs (see Fig. 1) and CYP2D6 can metabolize compounds with a wide range of structures such as beta-blockers, tricyclic antidepressants, antiarrhythmics, and dextromethorphan, a component of cough suppressants. This enzyme also converts the inactive analgesic codeine to its active derivative morphine.

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