Combined statin-fibrate therapy-induced rhabdomyolysis: Case report

Jozić, Tanja; Terzić, Branka; Mitrović, M; Kostić, Jasminka; Milanov, M; Stojanović, Milena; Ašanin, Milika

doi:10.5937/hpimj1401022j

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…Combined statin and fibrate therapy may lead to rhabdomyolysis and according to the recommendations of the American Heart Association fenofibrate is the preferred fibrate to use in combination with statins because of a reduced incidence of DDIs compared with statin-gemfibrozil combination therapy (Wiggins et al, 2016). However, even a combination with fenofibrate was associated with the occurrence of rhabdomyolysis in ACS patients, so caution is certainly needed even when fenofibrate is prescribed (Jozic et al, 2014). CRP, a prognostic marker of recurrent nonfatal myocardial infarction or cardiac death in NSTEMI, and marker which may reflect the extent of myocardial injury in STEMI (del Val Martin, Sanmartín Fernández, Zamorano Gómez, 2015), was also associated with increased risk of statin pDDIs in our study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

Pejčić

Janković

Davidović

2022

Braz. J. Pharm. Sci.

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The aim of our study was to assess risk factors for potential drug-drug interactions (pDDIs) of statins across different phases of treatment of acute coronary syndrome (ACS) patients: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase) and at discharge from hospital (third phase). This was a post hoc analysis of the data collected during the retrospective observational cohort study conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, Serbia. Patients prescribed statins were identified from the original study population: 156, 240 and 236 patients for the first, second and third phases, respectively. At least one statin pDDI was present in 113 (72.4%), 161 (67.1%) and 139 (58.9%) patients in the first, second and third phases, respectively. Heart failure, arrhythmias after ACS, CRP, triglycerides, length of hospitalization, number of prescribed drugs, antiarrhythmic drugs, and clopidogrel seem to increase the risk of statin pDDIs in at least one treatment phase. Physicians should be vigilant to the possibility of statin pDDIs in ACS patients who have factors that may increase their rate.

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Section: Discussionmentioning

confidence: 99%

Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

Pejčić

Janković

Davidović

2022

Braz. J. Pharm. Sci.

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“…Another report by Jozić et al . described rhabdomyolysis in a patient in whom rosuvastatin was replaced with pravastatin and gemfibrozil [ 28 ]. Similar to our case, the patient was on long-term high-dose statin and occurrence of rhabdomyolysis followed the addition of a second lipid-lowering agent.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of severe rhabdomyolysis leading to acute kidney injury following atorvastatin-gemfibrozil combination therapy: a case report

2018

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BackgroundRhabdomyolysis is a rare but serious complication of lipid-lowering therapy. Statin and fibrate combination increases the risk of rhabdomyolysis possibly by pharmacodynamic interactions. Advanced age, diabetes, hypothyroidism, polypharmacy, and renal impairment are known to increase the risk of rhabdomyolysis. Management strategies include fluid resuscitation and urine alkalinization. Renal indications such as refractory hyperkalemia, acidosis, fluid overload, or uremic complications mandate renal replacement therapy in rhabdomyolysis.Case presentationWe report the case of a 62-year-old Sri Lankan Sinhalese man with dyslipidemia, type 2 diabetes mellitus with renal impairment, and hypothyroidism who was on atorvastatin; he was started on gemfibrozil and developed muscle symptoms. Although gemfibrozil was discontinued soon after, he presented with rhabdomyolysis with acute kidney injury 1 month later. He needed hemodialysis due to refractory hyperkalemia, metabolic acidosis, and fluid overload.ConclusionsRhabdomyolysis is a rare but serious complication due to lipid-lowering therapy with statins and fibrates. Treating physicians should be aware and patients should be warned to report about muscle symptoms after starting statins or fibrates. Rhabdomyolysis may occur with mild symptoms and signs and may occur later, even after discontinuation of the drug.

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Drug-Drug Interactions in Acute Coronary Syndrome Patients: Systematic Review

Pejčić

Janković

Davidović

2019

Serbian Journal of Experimental and Clinical Research

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Drug-drug interaction (DDI) is defined as a clinically significant change in the exposure and/or response to a drug caused by co-administration of another drug which may result in a precipitation of an adverse event or alteration of its therapeutic effects. The aim of this systematic review was to provide an overview of DDIs that were actually observed or evaluated in acute coronary syndrome (ACS) patients with particular focus on DDIs with clinical relevance. Electronic searches of the literature were conducted in the following databases: MEDLINE, EBSCO, Scopus, Google Scholar and SCIndeks. A total of 117 articles were included in the review. This review showed that ACS patients can be exposed to a variety of DDIs with diverse outcomes which include decreased efficacy of antiplatelet drugs, thrombolytics or anticoagulants, increased risk of bleeding, rhabdomyolysis, hepatotoxicity, adverse effects on cardiovascular system (e.g. QT interval prolongation, arrhythmias, excessive bradycardia, severe hypotension), serotonin syndrome and drug-induced fever. Majority of the DDIs involved antiplatelet drugs (e.g. aspirin, clopidogrel and ticagrelor). Evidence of some of the reported DDIs is inconclusive as some of the studies have shown conflicting results. There is a need for additional post-marketing and population-based studies to evaluate the true effects of disease states and other factors on the clinical outcomes of DDIs. Clinicians should be attentive to the potential for DDIs and their associated harm in order to minimize or, if possible, avoid medication-related adverse events in ACS patients.

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Combined statin-fibrate therapy-induced rhabdomyolysis: Case report

Cited by 3 publications

References 12 publications

Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

Delayed presentation of severe rhabdomyolysis leading to acute kidney injury following atorvastatin-gemfibrozil combination therapy: a case report

Drug-Drug Interactions in Acute Coronary Syndrome Patients: Systematic Review

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