Rhabdomyolysis with atorvastatin and fusidic acid
C O'Mahony1, V L Campbell, M S Al-Khayatt
1The Heart Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK. c.omahony@doctors.org.uk
Postgraduate Medical Journal
|July 23, 2008
Summary
Statin therapy can rarely cause rhabdomyolysis. This case highlights how drug interactions, like fusidic acid with atorvastatin, can increase this risk.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Medicine
Background:
- Statin medications are widely prescribed for cholesterol management.
- Rhabdomyolysis, a serious condition involving muscle breakdown, is a known rare side effect of statin use.
- Drug interactions represent a significant factor in adverse drug events.
Observation:
- A 74-year-old male patient on atorvastatin experienced rhabdomyolysis.
- The onset of rhabdomyolysis occurred after concurrent administration of fusidic acid and flucloxacillin.
- The patient's condition improved with supportive care.
Findings:
- Co-administration of fusidic acid and flucloxacillin with atorvastatin precipitated rhabdomyolysis.
- Plasma concentrations of statins can increase due to pharmacokinetic interactions.
- Predisposing biological factors may enhance the risk of statin-induced rhabdomyolysis.
Implications:
- Clinicians should exercise caution when prescribing fusidic acid or flucloxacillin to patients on statin therapy.
- Awareness of potential drug interactions is crucial for preventing severe adverse events like rhabdomyolysis.
- Reintroduction of atorvastatin was tolerated after the resolution of the acute event, suggesting a transient interaction effect.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
Hyperlipidemia, a medical condition often referred to as high cholesterol, is characterized by abnormally elevated levels of lipids in the bloodstream. When present in excess, these lipids, specifically cholesterol and triglycerides, can lead to serious health complications, often involving cardiovascular diseases. Illnesses like atherosclerosis, heart attacks, and pancreatitis have all been linked to untreated hyperlipidemia. This means controlling and regulating cholesterol and triglyceride...
01:30Drug toxicity: Drug–Drug Interaction
Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
01:24Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
In the intricate landscape of the gastric lumen, excessive acid secretion disrupts the natural defense mechanisms, weakening the mucus-bicarbonate barrier. This vulnerability allows pepsin to infiltrate epithelial cells, digesting mucosal proteins and triggering erosion, leading to ulcer formation.
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
01:11Renal Failure: Dose Adjustments
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:31Acid Suppressive Drugs for Peptic Ulcer Disease: Antacids
In the complex environment of the gastric lumen, excessive acid secretion can lead to the formation or worsening of ulcers within the delicate mucosal layer. Antacids, such as sodium bicarbonate and calcium carbonate, provide relief by neutralizing this acid, transforming it into harmless salt and water. This neutralization process raises the gastric pH from a highly acidic level of 1 to a more basic 3-4, reducing the acidity within the stomach.
However, this neutralization reaction between...
However, this neutralization reaction between...
01:13Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
Peptic ulcers, often induced by H. pylori infections or NSAID usage, arise from disruptions in the delicate balance of gastric acid production. Peptic ulcers stem from heightened gastric acid levels due to H. pylori infections or NSAID use. The protective mucus layer diminishes in the presence of these factors, allowing gastric acid to erode the stomach lining and form ulcers.
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...