CYP3A4 and Abnormal renal physiology: Risk factors include higher statin doses, older age, female sex, renal dysfunction, and interactions with medications or supplements that impair statin metabolism, for instance, inhibitors of cytochrome P450 3A4 (CYP3A4) or cytochrome P450 2C9 (CYP2C9), as well as substrates of organic anion transporting polypeptides (OATPs), such as OATP1B1.