A rare rosuvastatin-clarithromycin interaction presenting with acute liver injury and delayed rhabdomyolysis

Area of Science:

• Pharmacology
• Clinical Toxicology
• Internal Medicine

Background:

• Rosuvastatin, a hydrophilic statin, typically has a low interaction risk with macrolides.
• Current guidance suggests concurrent use with clarithromycin is not contraindicated.
• However, rare severe toxicities have been documented, especially in vulnerable patient groups.

Purpose of the Study:

• To report a case of severe rosuvastatin toxicity.
• To highlight a potential drug-drug interaction between rosuvastatin and clarithromycin.
• To emphasize the importance of recognizing this interaction in specific patient populations.

Main Methods:

• Case report of a 69-year-old male patient.
• Concurrent administration of high-dose rosuvastatin and clarithromycin.
• Monitoring for adverse events, including liver enzymes and muscle damage.
• Intervention included withdrawal of both drugs and supportive care.

Main Results:

• The patient developed marked transaminase elevation and severe rhabdomyolysis.
• Biochemical parameters improved rapidly after discontinuing rosuvastatin and clarithromycin.
• Supportive treatment included intravenous N-acetylcysteine and ursodeoxycholic acid.
• The patient's death was attributed to refractory shock from his critical illness, not the drug interaction.

Conclusions:

• A rare but clinically significant interaction between rosuvastatin and macrolide antibiotics, like clarithromycin, can occur.
• This interaction may be under-recognized, particularly in elderly or critically ill patients.
• Vigilance and prompt management are essential when these drugs are co-administered.