Rhabdomyolysis and Acute Renal Graft Impairment in a Patient Treated with Simvastatin, Tacrolimus, and Fusidic Acid

Rhabdomyolysis after Transplantation: Case Report after Allogeneic Hematopoietic Transplantation and Review of Literature

“…Twenty cases of rhabdomyolysis have been reported after solid organ transplantation [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], 2 cases after allogeneic hematopoietic stem cell transplantation [5,6] while 5 cases of rhabdomyolysis occurred in patients assuming cyclosporine for other clinical reasons [7,[43][44][45][46]. In heart transplant recipients treated with statins, frequency of myopathy was estimated between 10% and 20% [47], while in a retrospective study of patients who underwent marrow transplant and were treated with statins, myopathy was found in 1% [13].…”

“…The incidence of rhabdomyolysis is also increased by the concomitant use of statins metabolized by CYP3A4 together with agents that inhibit CYP3A4, such as azoles, verapamil, diltiazem, amiodarone, protease inhibitors, fibrate, tricyclic antidepressants, midazolam, tamoxifen and macrolides [8,22]. Accordingly, in 9 out of the 22 case reports of myopathy occurring as an adverse effect of statins after transplantation [5,6, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], the patients receiving a statin and cyclosporine were also treated concomitantly with agents inhibiting CYP3A4, as follows: risperidone (1 case), verapamil (1 case), macrolides (1 case), itraconazole (1 case), clopidogrel (1 case), fibrate (1 case), fusidic acid (1 case), gemfibrozil (1 case) and multiple agents (1 case). In the other 13 cases, rhabdomyolysis was associated with the concomitant use only of cyclosporine and statins.…”

Rhabdomyolysis following co-prescription of fusidic acid and atorvastatin

“…11,12 We later found seven case reports of rhabdomyolysis due to a fusidic acid-statin interaction, including four of fusidic acid with atorvastatin [13][14][15][16] and three of fusidic acid with simvastatin. [17][18][19] Fusidic acid was the only CYP3A4 inhibitor prescribed in five of these reports. Despite this, the risk of an interaction between statins and fusidic acid is mentioned in only one 1 of eight recent reviews of statin toxicity.…”

Rhabdomyolysis after co-prescription of statin and fusidic acid

“…The patients' characteristics are similar to those of 18 previously reported cases (table 2⇓). [6][7][8][9][10][11][12][13][14][15][16][17] .…”