Why does statin cause rhabdomyolysis

Recurrent muscle pain was common on statin rechallenge, but predictors of intolerance to multiple statins were not identified in this small study.

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View Large Download. Table 1. Clinical Features and Hospitalization for Rhabdomyolysis. Cholesterol and Recurrent Events Trial investigators, The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.

West of Scotland Coronary Prevention Study Group, Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study.

A novel anti-inflammatory role for simvastatin in inflammatory arthritis. Evans MRees A The myotoxicity of statins. Long-term safety and efficacy of combination gemfibrozil and HMG-CoA reductase inhibitors for the treatment of mixed lipid disorders. Gutierrez CA Sildenafil-simvastatin interaction: possible cause of rhabdomyolysis? Tomlinson BLan IW Combination therapy with cerivastatin and gemfibrozil causing rhabdomyolysis: is the interaction predictable?

Geneva, Switzerland World Health Organization;. Statin-associated myopathy with normal creatine kinase levels. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. Save Preferences. Privacy Policy Terms of Use. This Issue. Citations View Metrics. Twitter Facebook More LinkedIn.

Original Investigation. Karen E. Hansen, MD ; Julie P. Hildebrand, MD ; Edwin E. Ferguson, MD ; et al James H. Stein, MD. Statistical analysis. Longitudinal data. Back to top Article Information. Access your subscriptions. Access through your institution. Add or change institution. Free access to newly published articles. Purchase access. Rent article Rent this article from DeepDyve. Access to free article PDF downloads. Save your search. Customize your interests. Create a personal account or sign in to:.

Rhabdomyolysis is characterized by the breakdown of skeletal muscle, resulting in the release of sarcoplasmic proteins including AST, ALT and CK and electrolytes. It typically presents with myalgia and muscle weakness of the proximal musculature. Patients may report dark urine as a result of myoglobinuria. Potentially life-threatening complications include AKI, hyperkalaemia, compartment syndrome and cardiac arrhythmias.

Early rehydration and electrolyte correction is essential in preventing complications, as well as addressing the precipitating cause. One study conducted by the U. In this case the patient was prescribed 80mg of simvastatin daily; a higher dose associated with an increased risk of statin myopathy.

The U. FDA does not recommend initiating new patients on a simvastatin dose of 80 mg, to minimize the risk of statin-induced-myopathy and rhabdomyolysis [ 6 ].

Clarithromycin is a macrolide antibiotic and a CYP3A4 inhibitor. It has previously been shown to cause rhabdomyolysis in patients taking simvastatin [ 7 ]. AKI is a serious complication of rhabdomyolysis and a recent case described a patient requiring haemodialysis for statin-induced-rhabdomyolysis after being prescribed clarithromycin [ 8 ].

Fluvastatin, pravastatin and rosuvastatin may be considered as alternatives as they are not as extensively metabolized by CYP3A4 and therefore less likely to result in rhabdomyolysis but still require careful monitoring [ 9 ]. This case highlights the need for awareness of important drug interactions in an era of increasing polypharmacy and the morbidity that can result when these interactions are overlooked.

We have not identified any direct or indirect potential patient identifiers in our case report. The patient has provided their informed consent for the publication of this case report. National Center for Biotechnology Information , U. Oxf Med Case Reports.

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