Rhabdomyolysis in an elderly multitreated patient: multiple drug interactions after statin withdrawal
Federica Ginanneschi1, Nila Volpi1, Fabio Giannini1
1Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy.
Journal of the Neurological Sciences
|November 21, 2013
Summary
Rhabdomyolysis, a severe muscle condition, can occur in elderly patients even after stopping statins due to drug interactions. Polypharmacy increases the risk of these dangerous muscle side effects.
Area of Science:
- Pharmacology
- Geriatrics
- Toxicology
Background:
- Multitherapy-induced rhabdomyolysis is commonly linked to statin use, primarily through cytochrome P450 pathway interactions.
- Drug interactions affecting membrane transporters can also alter tissue drug levels, contributing to adverse effects.
Observation:
- A case of rhabdomyolysis is presented in an elderly patient on multiple medications, occurring seven months after discontinuing atorvastatin.
- The patient experienced elevated creatine kinase and severe weakness despite atorvastatin withdrawal, following the introduction of ranolazine.
Findings:
- Muscle biopsy revealed necrotizing myopathy without inflammatory or autoimmune signs.
- Withdrawal of ranolazine led to normalization of creatine kinase and myoglobin levels, with restoration of muscle strength.
Implications:
- This case highlights the risk of severe muscle adverse effects from pharmacokinetic drug-drug interactions in geriatric patients with cardiovascular/neuropsychiatric polypharmacy.
- The potential for drug-induced myopathy should be considered beyond the direct toxicity of statins, especially with complex medication regimens.
Related Concept Videos
01:30Drug toxicity: Drug–Drug Interaction
437
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...
437
01:15Drug Dosing: Geriatric Patients
400
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
400
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
405
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
405
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
358
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
358
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
1.8K
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...
1.8K
01:24Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
428
Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
428