Diclofenac- and Pantoprazole-Induced Rhabdomyolysis: A Potential Drug Interaction

Abstract

BackgroundDrugs represent one of the etiologic causes of acute rhabdomyolysis (AR) with drug-induced rhabdomyolysis most commonly associated with HMG-CoA reductase inhibitors. AR etiology can also result from the use of diclofenac, a non-steroidal anti-inflammatory drug, and omeprazole, a proton pump inhibitor. Cases of AR triggered by pantoprazole have never before been reported, although it has been observed that its inclusion in multiple drug therapies can result in muscle events.Case presentationA 45-year-old man presenting with complaints of fatigue and extensive body pain was diagnosed with acute rhabdomyolysis. His symptoms started on the fourth day of the concomitant use of diclofenac and pantoprazole. The patient was using diclofenac 50-mg tablets once daily for 1 month and pantoprazole 40-mg tablets once daily during the previous week for headaches and pyrosis, resulting in an increase in his creatinine kinase levels to 3114 IU/L (reference range 24–190 IU/L) on the fifth day of concomitant use. His creatinine kinase levels returned to normal and his complaints disappeared after the seventh day of discontinuation of both treatments.DiscussionA third case of diclofenac-induced rhabdomyolysis was defined in which, different from previous cases, AR was detected during the concomitant use of diclofenac and pantoprazole. The timing of the symptom development and the limited number of AR cases induced by diclofenac and pantoprazole suggested a drug interaction.ConclusionThe close relationship between diclofenac and pantoprazole, and the cytochrome P450 and P-glycoprotein systems offers a strong indication that a drug interaction may be occurring. While evaluating the side effects of drugs in patients undergoing monotherapy, clinicians should also consider the mechanisms that play a part in drug absorption and distribution.

Lipin-1 Deficiency-Associated Recurrent Rhabdomyolysis and Exercise-Induced Myalgia Persisting into Adulthood: A Case Report and Review of Literature

“…Even though endogenous estrogen appears to attenuate muscle damage in animals, women taking oral contraceptives, thereby having higher exogenous estrogen levels with lower endogenous estrogen levels, appear to be more susceptible to exerciseinduced muscle damage and have an attenuated recovery from exercise-induced muscle damage [16][17][18]. ere are a few case reports of RML developing after administration of diclofenac sodium, but RML following administration of mefenamic acid has not been reported [19][20][21]. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac sodium and mefenamic acid, have been suggested to cause cell injury by inducing proteasome dysfunction and uncoupling mitochondrial oxidative phosphorylation, resulting in decreased ATP synthesis [22,23].…”

Rhabdomyolysis: an unusual complication following diclofenac and amitraz consumption

“…Myoglobin results in acute tubular necrosis through renal vasoconstriction, formation of intratubular casts and the direct toxicity of myoglobin on renal tubular cells. 4,5,[8][9][10] The complications include hyperkalemia, hypocalcemia, acute renal failure, disseminated intravascular coagulation and cardiac arrest. It can occur due to a variety of causes including crush injury, viral infections, inflammatory myopathies, extremes of body temperature, drugs of abuse like cocaine and medications like statins, antipsychotics, antidepressants, antihistamines, antiepileptic agents, sedative and hypnotic agents.…”

“…It can occur due to a variety of causes including crush injury, viral infections, inflammatory myopathies, extremes of body temperature, drugs of abuse like cocaine and medications like statins, antipsychotics, antidepressants, antihistamines, antiepileptic agents, sedative and hypnotic agents. 4,5 Considering the life-threatening implications of this condition, an early detection and initiation of treatment is necessary.…”

“…Rhabdomyolysis, involving the disintegration of skeletal muscle releasing the muscle constituents into the bloodstream, is a potentially life-threatening condition due to multiple traumatic and non-traumatic causes. 4,5 However, it has rarely been associated with the consumption of either of the above two compounds.…”

Tikagrelor Kullanımı Atorvastatin İlişkili Rabdomiyoliz Riskini Artırabilir

“…Diklofenak sodyum da yine sitokrom p450 üzerinden elimine edilmektedir (11). Diklofenak sodyum kullanımı da olgumuzda rabdomiyoliz ve ilişkili böbrek hasarı gelişimine katkıda bulunmuş olabilir.…”