1/133. Judicious evaluation of adverse drug reactions: inaccurate assessment of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor-induced muscle injury.Adverse reactions in two patients who received HMG CoA reductase inhibitor therapy were reinvestigated because of their rarity. A case of permanent forearm myalgia was thought to be caused by atorvastatin. Closer evaluation and work-up revealed underlying lateral epicondylitis, and atorvastatin was not considered the cause of the disability. In another patient, rhabdomyolysis was suspected to be secondary to simvastatin. However, after an extensive review, the reaction was believed to be compartment syndrome of the anterior tibial area. An adverse drug reaction report requires careful and judicious assessment to assign the correct probability for the event.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/133. cocaine-associated rhabdomyolysis and excited delirium: different stages of the same syndrome.Previous case reports indicate that cocaine-associated rhabdomyolysis and excited delirium share many similar features, suggesting that they may be different stages of the same syndrome. We tested this hypothesis by comparing data from 150 cases of cocaine-associated rhabdomyolysis reported in the medical literature with data from an autopsy registry for 58 victims of fatal excited delirium and 125 victims of fatal acute cocaine toxicity. patients with rhabdomyolysis are similar to victims of fatal excited delirium with regard to age; gender; race; route of cocaine administration; the experiencing of excitement, delirium, and hyperthermia; and the absence of seizures. Compared with victims of fatal acute cocaine toxicity, patients with rhabdomyolysis are different with regard to each of these variables. Compared with victims of fatal acute cocaine toxicity, both victims of rhabdomyolysis and fatal excited delirium are more likely to be black, male, and younger; to have administered cocaine by smoking or injection; and to have experienced excitement, delirium, and hyperthermia; they are also less likely to have had seizures. Because cocaine-associated rhabdomyolysis and excited delirium have similar clinical features and risk factors, occur in similar populations of drug users, and can be explained by the same pathophysiologic processes, we conclude that they are different stages of the same syndrome. It appears that this syndrome is caused by changes in dopamine processing induced by chronic and intense use of cocaine rather than by the acute toxic effects of the drug.- - - - - - - - - - ranking = 0.4keywords = drug (Clic here for more details about this article) |
3/133. rhabdomyolysis associated with concomitant use of atorvastatin and cyclosporine.OBJECTIVE: To describe a case of rhabdomyolysis in a cadaveric renal transplant (CRT) patient receiving atorvastatin and cyclosporine. CASE SUMMARY: A 40-year-old Asian woman with a history of systemic lupus erythematosus (SLE) presented with bilateral lower-extremity weakness and elevated concentrations of creatine kinase (CK), aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and alkaline phosphatase after two months of concomitant therapy with atorvastatin and cyclosporine. Her other medications were not known to cause rhabdomyolysis; neither was there evidence of an SLE flare. After atorvastatin was discontinued, her CK concentrations declined dramatically and her symptoms resolved. DISCUSSION: rhabdomyolysis has been reported in patients treated with other 3-hydroxy-3-methylglutaryl coenzyme a (HMG-CoA) reductase inhibitors when used in combination with cyclosporine. Atorvastatin, a relatively new HMG-CoA reductase inhibitor, has not been reported to cause rhabdomyolysis when used concomitantly with cyclosporine. However, its pharmacologic and pharmacokinetic properties make an interaction with cyclosporine possible. CONCLUSIONS: Similar to other members of the HMG-CoA reductase inhibitor class, atorvastatin may interact with cyclosporine and potentially result in rhabdomyolysis. Clinicians should be aware of this possible drug interaction and carefully monitor patients receiving these two drugs concomitantly.- - - - - - - - - - ranking = 0.4keywords = drug (Clic here for more details about this article) |
4/133. Acute renal failure after cardiopulmonary bypass: a possible association with drugs of the fibrate group.BACKGROUND: Renal failure is a recognized, but infrequent, complication following cardiac surgery. The causes for this condition are multifactorial, and a major concern is that the occurrence of postoperative acute renal failure is still associated with a high mortality rate. methods AND MATERIALS: We report unexpected acute renal failure occurring in 4 patients after uncomplicated cardiac surgery. Each patient was taking a fibric acid derivative at the time of surgery. Renal failure occurred rapidly within 3 days of surgery and was associated with increased concentrations of skeletal muscle-derived creatine kinase (CK). One patient developed myoglobinuria, and another developed a malignant hyperthermia-like syndrome. CONCLUSIONS: These cases show that patients receiving lipid lowering medications could be at higher risk of developing acute renal failure after cardiac surgery. This association merits careful evaluation in large prospective studies and, if proved, would suggest that patients taking either statins or fibrates should discontinue doing so before cardiac surgery.- - - - - - - - - - ranking = 0.8keywords = drug (Clic here for more details about this article) |
5/133. rhabdomyolysis in a patient receiving the combination of cerivastatin and gemfibrozil.Straightforward reports of unusual drug experiences are included in this section. While selected references may be cited, the purpose of a Drug Experience report is not to present an extensive review of the literature. A related section, Grand Rounds, includes papers that are well-documented patient case reports with a thorough review of the important literature to help put the case in perspective. Authors should report serious adverse drug reactions to the FDA medical products reporting program (MedWatch). Such reporting will not jeopardize the chances that AJHP will publish manuscripts on the same drug reactions.- - - - - - - - - - ranking = 0.6keywords = drug (Clic here for more details about this article) |
6/133. simvastatin-induced rhabdomyolysis in a patient with chronic renal failure.simvastatin belongs to a class of lipid-lowering drugs which completely inhibit 3-hydroxy-3-methylglutaryl co-enzyme A (HMG CoA) reductase. The commonest adverse effects of therapy with simvastatin HMG CoA reductase inhibitors are gastro-intestinal disturbance, myositis and myopathy. rhabdomyolysis leading to renal failure has been reported, but it appears to be very rare, except in patients also receiving cyclosporin, nicotinic acid or gemfibrozil. Here we report the case of an elderly lady who was known to have chronic renal failure, but who developed rhabdomyolysis following simvastatin therapy. Her symptoms of muscle pain, fatigue, myoglobulinuria, oliguria and pulmonary oedema appeared 48 h after the first dose of simvastatin. simvastatin was immediately stopped, and the patient was dialysed for 1 week. Her renal function improved and came back. We suggest that extreme care should be exercised in prescribing this drug, particularly for the elderly with renal impairment.- - - - - - - - - - ranking = 0.4keywords = drug (Clic here for more details about this article) |
7/133. Cyclosporin drug-interaction-induced rhabdomyolysis. A report of two cases in lung transplant recipients.In rare cases the use of cyclosporin in transplant patients can cause myopathic changes. We describe two patients, the recipients of lung transplants, who developed severe reversible rhabdomyolysis associated with cyclosporin drug-drug interaction.- - - - - - - - - - ranking = 1.2keywords = drug (Clic here for more details about this article) |
8/133. A case with severe rhabdomyolysis and renal failure associated with cerivastatin-gemfibrozil combination therapy--a case report.gemfibrozil-statin combination therapy is a well-known risk factor for myopathy and rhabdomyolysis. Cerivastatin is a currently available statin with dual elimination; it is therefore expected to cause less drug-drug interaction. This case is the second reported case with severe rhabdomyolysis caused by cerivastatin-gemfibrozil combination. Moreover, in this case, the rhabdomyolysis was more severe and caused severe renal failure and death. The authors discuss how these drugs cause rhabdomyolysis and how rhabdomyolysis can cause renal failure.- - - - - - - - - - ranking = 0.6keywords = drug (Clic here for more details about this article) |
9/133. rhabdomyolysis and acute renal failure in a cardiac transplant recipient due to multiple drug interactions.BACKGROUND: The 3-hydroxy-3-methyl-glutaryl-coenzyme a reductase inhibitors lovastatin and simvastatin have been associated with rhabdomyolysis in cardiac transplant recipients. Herein, we report a case of a 52-year-old male recipient of a cardiac transplant who developed rhabdomyolysis and acute renal failure caused by simvastatin precipitated by multiple drug interactions. methods: The patient had a history of cardiac transplantation (5 years before) and presented with a 2-day history of dark urine preceded by 2 weeks of diffuse myalgias. He had been maintained on cyclosporine throughout the entire post-transplant period. simvastatin was added and pravastatin was discontinued 2 months before admission. Two weeks before the onset of muscle symptoms, digoxin and verapamil were started for new-onset atrial fibrillation. creatinine phosphokinase levels peaked at 950,000 IU with serum creatinine of 3.3 mg/dL (baseline, 1.8 mg/dL). RESULTS: review of the medication history indicates a temporal association between the addition of 3 drugs (simvastatin, verapamil, and digoxin) to the medication regimen already containing cyclosporine and the episode of rhabdomyolysis. All of these drugs are cytochrome P450 3A4 and/or p-glycoprotein substrates that are known from previous pharmacokinetic studies to individually produce substantial increases in levels of simvastatin. CONCLUSION: We believe this case illustrates that avoiding the use of drugs that are cytochrome P450 3A4 and/or p-glycoprotein substrates reduces the risk of rhabdomyolysis caused by 3-hydroxy-3-methyl-glutaryl-coenzyme a reductase inhibitors.- - - - - - - - - - ranking = 1.6keywords = drug (Clic here for more details about this article) |
10/133. rhabdomyolysis and acute renal failure after changing statin-fibrate combinations.Statin-fibrate combinations are commonly used to treat hyperlipidemia. These drugs have been previously reported to cause rhabdomyolysis with acute renal failure. Whether different statin-fibrate combinations have different risks for rhabdomyolysis is not known. We report a patient who developed rhabdomyolysis with acute renal failure promptly after switching from the combination of pravastatin and fenofibrate to simvastatin and gemfibrozil.- - - - - - - - - - ranking = 0.2keywords = drug (Clic here for more details about this article) |
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