Pioglitazone-Induced Acute Rhabdomyolysis

Slim, Raoudha; Salem, Chaker Ben; Zamy, Michele; Biour, M

doi:10.2337/dc09-0593

Cited by 23 publications

(17 citation statements)

References 8 publications

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“…485 Evaluation of the transcriptome of skeletal muscle of subjects with impaired glucose tolerance on pioglitazone therapy did not reveal any metabolic pathways that were modulated by pioglitazone. 486 TZDs appear to be relatively safe, and although acute rhabdomyolysis after pioglitazone use has been reported, 487 other skeletal muscle-related adverse events appear to be uncommon with TZD use. 488 The majority of the studies support a positive or neutral effect of TZDs on skeletal muscle, however additional studies are required to confirm these effects, particularly in the diabetic population.…”

Section: Thiazolidinedionesmentioning

confidence: 99%

Diabetes pharmacotherapy and effects on the musculoskeletal system

Kalaitzoglou

Fowlkes

Popescu

et al. 2018

Diabetes Metabolism Res

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Summary Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age‐matched persons without diabetes, attributed to disease‐specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin‐based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall‐related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo‐anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in type 2 diabetes, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium‐dependent glucose co‐transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bone quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes‐related muscle atrophy is more limited, although preclinical studies suggest that various hypoglycemic agents may have either aggravating (sulfonylureas, glinides) or repairing (thiazolidinediones, biguanides, incretins) effects on skeletal muscle atrophy, thereby influencing bone quality. Hence, the therapeutic efficacy of each hypoglycemic agent must also be evaluated in light of its impact, alone or in combination, on musculoskeletal health, when determining an individualized treatment approach. Moreover, the effect of newer medications (potentially seeking expanded clinical indication into the pediatric age range) on the growing skeleton is largely unknown. Herein, we review the available literature regarding effects of diabetes pharmacotherapy, by drug class and/or by clinical indication, on the musculoskeletal health of persons with diabetes.

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Section: Thiazolidinedionesmentioning

confidence: 99%

Diabetes pharmacotherapy and effects on the musculoskeletal system

Kalaitzoglou

Fowlkes

Popescu

et al. 2018

Diabetes Metabolism Res

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“…Increased activity of PPAR-γ has been associated with myalgia and rhabdomyolysis. Drugs that primarily modulate PPAR-γ activity, such as pioglitazone, troglitazone and rosiglitazone, are associated with similar adverse events; thus, the off-target action of telmisartan on PPAR-γ activity could be one of the reasons for myotoxicity in our case [10][11][12]. Lipophilicity is an important factor that enables drugs to cross cell membranes, and lipophilic drugs have greater affinity for the PPAR-γ receptor.…”

Section: Discussionmentioning

confidence: 91%

Safety of olmesartan in a patient with telmisartan‐induced myotoxicity: a case report

Barvaliya

Naik

Shah³

et al. 2015

Brit J Clinical Pharma

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“…Another described its association during the concomitant use with an antipsychotic drug [15]. To our knowledge, there have been no reports in the literature describing a direct link between metformin and rhabdomyolysis, although there have been case reports connecting other antidiabetic agents to rhabdomyolysis, such as sitagliptin, rosiglitazone, pioglitazone, and troglitazone [16][17][18][19]. In all of the cases, the described association has occurred in patients who were also taking other medications in addition to the antidiabetic agent of interest, including ones notoriously known to cause rhabdomyolysis, such as statins and fibrates.…”

Section: Discussionmentioning

confidence: 99%

McArdle disease: a “pediatric” disorder presenting in an adult with acute kidney injury

Zhao

Soni

et al. 2017

CEN Case Rep

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Rhabdomyolysis is characterized by the acute breakdown of skeletal muscle, resulting in the release of muscle cell contents, subsequent myoglobinuria, and in severe cases, acute renal failure. A number of etiologies have been identified in acute rhabdomyolysis, in which drugs and trauma account for the majority of cases. One etiological category that is commonly overlooked in the adult population is an underlying genetic defect. This may be challenging to diagnose due to its rarity in the adult demographic and the marked heterogeneity, often requiring a high level of clinical suspicion before investigation is pursued. Once diagnosed, however, appropriate steps can be taken to reduce future episodes of rhabdomyolysis, further renal injury, and other systemic complications. Here, we report a case of an adult patient presenting with acute rhabdomyolysis secondary to McArdle disease, a genetic disease causing defective glycogenolysis. The case highlights the importance of recognizing the potential of undiagnosed ''pediatric'' disorders in adulthood and particularly for underlying genetic causes of rhabdomyolysis.

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Pioglitazone-Induced Acute Rhabdomyolysis

Cited by 23 publications

References 8 publications

Diabetes pharmacotherapy and effects on the musculoskeletal system

Diabetes pharmacotherapy and effects on the musculoskeletal system

Safety of olmesartan in a patient with telmisartan‐induced myotoxicity: a case report

McArdle disease: a “pediatric” disorder presenting in an adult with acute kidney injury

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