Rhabdomyolysis as a Clinical Manifestation of Association With Ciprofibrate, Sirolimus, Cyclosporine, and Pegylated Interferon-α in Liver-Transplanted Patients: A Case Report and Literature Review

Mitochondrial Respiratory Complexes as Targets of Drugs: The PPAR Agonist Example

“…Finally, it should be stressed that the data seem to indicate that, at therapeutic concentrations, PPAR ligands induce a partial derangement of mitochondrial NADH oxidation, but this derangement is enhanced by pharmacokinetic and/or pharmacodynamic interactions, as already dramatically shown in various clinical settings [ 44 , 45 , 46 , 47 , 48 ]. Moreover, it should be noted that small changes in cellular respiration and/or small derangements in respiratory control reflect significant mitochondrial damage, such as important alterations to the mitochondrial proteome and/or mtDNA, often associated with remarkable impairment to the mitochondrial signaling cascade.…”

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.…”

Liver Transplantation: the Role of Metabolic Syndrome

“…Atorvastatin has also been used in LTRs, but may require dose adjustment in patients on cyclosporine [82]. Although fibrates are effective and relatively safe, they should be used with caution in patients with CKD due to concern for increased risk of renal dysfunction, homocysteine levels, and rhabdomyolysis [83,84]. If fibrate use becomes necessary in patients with CKD stage 3-4, gemfibrozil is the drug of choice; however, it must be done with great caution [85].…”