Rhabdomyolysis resulting from the interaction of rosuvastatin and abiraterone: A case study

Abiraterone is a first-line therapy for metastatic castrate-resistant prostate cancer. In vitro, abiraterone metabolites inhibit OATP1B1, the primary hepatic uptake transporter for several substrates, including statins. We describe the case of a 70-year-old man taking rosuvastatin who commenced treatment with abiraterone for metastatic castrate-resistant prostate cancer. Two months later, he presented to hospital with nonspecific symptoms including fatigue and diffuse myalgias with laboratory evidence of rhabdomyolysis and associated acute kidney injury. Plasma rosuvastatin concentrations were more than 40-fold higher than expected for the dose. Subsequent pharmacogenetic testing showed the patient was heterozygous for SLCO1B1*15, a variant of the SLCO1B1 gene encoding OATP1B1, which results in moderately reduced OATP1B1 transport activity. Considering the high frequency of statin prescribing, clinicians should be aware of the possible drug-drug interactions between statins and abiraterone and the associated risk of rhabdomyolysis, which is also affected by genetic differences.