CYP3A4 and acute kidney injury: Inhibitors of CYP3A4 could reduce presystemic metabolism of CYP3A4-metabolized statins and increase their plasma concentrations.1 Therefore, CYP3A4 inhibitors such as macrolide antibiotics frequently result in drug interactions with statins.1,2 It has been reported that coprescription of macrolide antibiotics with CYP3A4-metabolized statins increases the risk of statin toxicity, such as acute kidney injury and hyperkalemia.3 These effects were acute and could be observed within 30 days of coprescription.