STATINS RELATED ACUTE RHABDOMYOLYSIS IN EMERGENCY DEPARTMENT STOPPING OR CHANGING STATIN DECISION
Keywords:
statins, myopathy, rhabdomyolysis, emergency department, biomarkers
Abstract
We report the case of a 72-year-old female patient, type IIB dyslipidemia, admitted in the ED for flu-like diffuse muscle pain, recently installed, progressive, apparently without a clear cause. For 3 months, the patient was being treated with gemfibrozilum and atorvastatin. The patient had suffered a myocardial infarction three years ago and right adrenalectomy as a cure for secreting adenoma. Rhabdomyolysis and important metabolic acidosis led to the decision to replace the statin and dynamic supervision of the iatrogenic myopathy. After 10 days, the clinic was improved without further reported incident. The rhabdomyolysis trigger event seems to be, apparently, associated with adding gemfibrozil to the treatment, statin being previously tolerated without incidents. However, keeping gemfibrozilum and changing the statin type, the myopathy showed short-term improvement, which raises the issue of whether changing the treatment scheme is urgently needed or just observation might be enough. Conclusions: Type of calcium channel blockers associated with the treatment should be considered when choosing a statin. Routine monitoring renal function, muscle damage biomarkers, and serum potassium level should be considered in this circumstances It seems preferable for ED to recommend changing the statin, management, and myopathy follow up, against stopping statin administration. It is likely that the interaction between these two classes of drugs to be influenced by the previous adrenalectomy and low muscle glycogen reserves due to diabetes.
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References
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30. McKenney JM, Davidson MH, Jacobson TA, Guyton JR. Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment
Task Force. Am J Cardiol. 2006;97(suppl):89C-94C
2. Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med. 2009;150:858–68.
3. Omar M, Wilson J, Cox T. Rhabdomyolysis and HMG-CoA reductase inhibitors. Ann Pharmacother. 2001;35:1096–107
4. Gaist D, Rodríguez LA, Huerta C, Hallas J, Sindrup SH. Lipid-lowering drugs and the risk of myopathy: a population-based follow-up study. Epidemiology 2001;12:565-9.
5. Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD, La Grenade L, et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA 2004;292:2585-90
6. Brouwers P. Clinical Risk Stratification Optimizes Value of Biomarkers to Predict New-Onset Heart Failure in a Community-Based Cohort. Circ Heart Fail. 2014 Sep;7(5):723-31
7. Ristescu Irina, Grigoraș Ioana. Biomarkers în diagnostical precoce al sepsisului. Jurnalul de Chirurgie (Iaşi). 2012;(8)2
8. Vuilleumier N, Le Gal G, Verschuren F, Perrier A, Bounameaux H, Turck N, Sanchez JC, Mensi N, Perneger T, Hochstrasser D, Righini M. Cardiac biomarkers for risk stratification in nonmassive pulmonary embolism: a multicenter prospective study. J Thromb Haemost 2009;7:391–8.
9. Melli G, Chaudhry V, Cornblath DR; Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005 Nov;84(6):377-85.
10. Societatea Europeană de Cardiologie (ESC); Societatea Europeană de Ateroscleroză (EAS); Societatea Internațională de Medicină Comportamentală (ISBM); Organizația Europeană pentru Accidentele Vaculare Cerebral (ESO); Societatea Europeană de Hipertensiune (ESH); Asociația Europeană pentru studio Diabetului
(EASD); Societatea Europeană de Medicină Generală/Medicină de Familie(ESGP/ FM/WONCA); Federația Internațională de Diabet - Europa (IDFEurope); Rețeaua Europeană a Inimii (EHN). Ghidul European de prevenţie a bolilor cardiovascular în practica clinică(versiunea 2012) Romanian Journal of Cardiology 2014;24(4)
11. Chapman MJ, Ginsberg HN, Amarenco P, Andreotti F, Boren J, Catapano AL, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Nordestgaard BG, Ray KK, Reiner Z, Taskinen MR, Tokgozoglu L, TybjaergHansen A, Watts GF. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J 2011;32:1345–61
12. Abd TT, Jacobson TA. Statin-induced myopathy: a review and update. Expert Opin Drug Saf. 2011;10:373–85
13. Cholesterol Treatment Trialists C. Efficacy and safety of more intensive lowering of LDL cholesterol: a metaanalysis of data from 170.000 participants in 26 randomised trials. 2010v
14. Harper CR, Jacobson TA. The broad spectrum of statin myopathy: from myalgia to rhabdomyolysis. Curr Opin Lipidol. 2007;18:401–8.
15. Sathasivam S, Lecky B. Statin-induced myopathy. BMJ. 2008;337:1159–62.
16. Craig S; Rhabdomyolysis in Emergency Medicine, Medscape, Dec 2010
17. Hansen KE, Hildebrand JP, Ferguson EE, Stein JH. Outcomes in 45 patients with statin-associated myopathy. Arch Intern Med 2005;165:2671-6.
18. Yi-Tingz Hou, Lu-Shan Yu. Pharmacokinetic drug-drug interactions between 1,4- dihydropyridine calcium channel blockers and statins: factors determining interaction strength and relevant clinical risk management. Ther Clin Risk Manag. 2014;10:17-26.DOI:10.2147/TCRM.S55512
19. Katoh M, Nakajima M, Shimada N, Yamazaki H, Yokoi T. Inhibition of human cytochrome P 450 enzymes by 1,4-dihydropyridine calcium antagonists: prediction of in vivo drug-drug interactions. Eur J Clin Pharmacol. 2000 Feb–Mar;55(11-12):84352
20. CADUETR.(amlodipine besylate/atorvastatin calcium) tablets,patient information. New York, NY; Pfizer Inc; 2012
21. Better OS, Abassi ZA; Early fluid resuscitation in patients with rhabdomyolysis. Nat Rev Nephrol. 2011 May 17.
22. Marx J.A., Hockberger R.S. Rosen’s emergency medicine – concepts and clinical practice, 6ed. MOSBY Elsevier by Mosby, Inc, ISBN 978-1-4557-0605-1, 2014
23. Glueck CJ, Aregawi D, Agloria M, et al. Rosuvastatin 5 and 10 mg/d: a pilot study of the effects in hypercholesterolemic adults unable to tolerate other statins and reach LDL cholesterol goals with non-statin lipidlowering therapies. Clin Ther. 2006;28:933–42.
24. Stein EA, Ballantyne CM, Windler E, et al. Efficacy and tolerability of fluvastatin XL 80 mg alone, ezetimibe alone, and the combination of fluvastatin XL 80 mg
with ezetimibe in patients with a history of muscle-related side effects with other statins. Am J Cardiol. 2008;101:490–6.
25. Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a metaanalysis of data from 170,000 participants in 26 randomized trials. Lancet 2010; 376: 1670–81.
26. Reiner Z. Combined therapy in the treatment of dyslipidemia. Fundam. Clin Pharmacol 2010;24:19–22
27. Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I, Larsen ML, Bendiksen FS, Lindahl C, Szarek M, Tsai J. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005;294:2437–45
28. Dunkelgrun M, Boersma E, Schouten O, Koopman-van Gemert AW, van Poorten F, Bax JJ, Thomson IR, Poldermans D; Dutch Echocardiographic Cardiac Risk
Evaluation Applying Stress Echocardiography Study Group. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg. 2009 Jun;249(6):921-6.
29. Stein EA, Ballantyne CM, Windler E, et al. Efficacy and tolerability of fluvastatin XL 80 mg alone, ezetimibe alone, and the combination of fluvastatin XL 80 mg with ezetimibe in patients with a history of muscle-related side effects with other statins. Am J Cardiol. 2008;101:490–6
30. McKenney JM, Davidson MH, Jacobson TA, Guyton JR. Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment
Task Force. Am J Cardiol. 2006;97(suppl):89C-94C
How to Cite
1.
Luciana Teodora Rotaru, Mihai Banicioiu – Covei, Mihaela Mormoe, Marius Ciprian Varut, Renata Maria Varut. STATINS RELATED ACUTE RHABDOMYOLYSIS IN EMERGENCY DEPARTMENT STOPPING OR CHANGING STATIN DECISION. Med. res. chronicles [Internet]. 2018Jun.30 [cited 2024Apr.20];5(3):231-6. Available from: https://medrech.com/index.php/medrech/article/view/308
Section
Case Report
