Rifaximin-Induced Rhabdomyolysis

Rifaximin is a non-absorbable oral antibiotic widely used for the management of traveler's diarrhea, hepatic encephalopathy, and irritable bowel syndrome diarrhea type. Although rifaximin is generally tolerated, rare cases of rhabdomyolysis have been reported, particularly in patients with cirrhosis with and without statin therapy. We reported a case of a 62-year-old male with a history of liver cirrhosis (ascites), hepatocellular carcinoma, and coronary artery disease (post coronary artery bypass grafting (CABG)) who presented with abdominal distension, generalized weakness, proximal muscle pain, and dark urine, with five years of atorvastatin medication without side effects. He was initiated on rifaximin (two weeks) for hepatic encephalopathy, along with lactulose, before experiencing proximal muscle pain and generalized weakness. This article will highlight our patient who developed rhabdomyolysis after initiating rifaximin with long-term use of statin, the trends of creatine kinase till resolution, and the treatment instituted.