Rhabdomyolysis caused by an unusual interaction between azithromycin and simvastatin

Abstract

Rhabdomyolysis is an uncommon but life-threatening adverse effect of simvastatin therapy. A 73-year-old male on chronic simvastatin therapy received azithromycin for acute bronchitis. He presented with weakness of all extremities with a significant increase in creatinine phosphokinase levels and acute kidney injury. Simvastatin was stopped and supportive therapy with intravenous saline and bicarbonate was initiated. The serum creatinine and creatine phosphokinase returned to baseline in the next 7 days. Two months later, simvastatin was resumed without any recurrence of symptoms. Our case report highlights the rare description of rhabdomyolysis caused by a drug interaction between simvastatin with azithromycin.

Atorvastatin and standard treatment of Helicobacter pylori: Randomized Clinical Trial

“…Studies have shown that clarithromycin inhibits CATP3A4 by inhibiting OATP1B1 and OATP1B3 cells in hepatocyte cells, which can lead to complications such as AV block, rhabdomyolysis, acute renal failure, hyperkalemia, and death (31)(32)(33)(34)(35)(36)(37). Therefore, the positive effect of statins on regimen containing clarithromycin may be due to the high accumulation of statins, which on the one hand increases the eradication rate of H. pylori eradication, but on the other hand will have dangerous side effects.…”

Drug Class Combination–Associated Acute Kidney Injury

“…Overall, reports of 56 combinations (73.7%) were considered VL quality ; 12 combinations (15.8%) were considered L quality. 10,11,[75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94] There were 8 (10.5%) combinations of M quality, 26,33,80,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] and no study was ranked as being of high quality. Of the combinations, 58 (76%) had a single article for review.…”

“…Three citations met inclusion criteria for the combination of statins and macrolides. [108][109][110] The proposed mechanism of nephrotoxicity occurs through increased serum statin concentrations as a result of inhibition of the cytochrome 450 (CYP450) enzyme system by macrolides. [108][109][110] This increase in serum statin concentrations leads to an increased risk of rhabdomyolysis.…”

Fabrication of a Selective and Sensitive Sensor Based on Molecularly Imprinted Polymer/Acetylene Black for the Determination of Azithromycin in Pharmaceuticals and Biological Samples

“…However, several side effects will occur when the accumulated dose of AZM exceeds a certain value. Several studies showed that AZM may increase the risk of cardiovascular death and that the interaction between AZM and simvastatin may cause rhabdomyolysis [ 4 , 5 ]. Therefore, the rapid, sensitive, and reliable determination of AZM dosage is of great significance from a health viewpoint.…”