Thursday January 15, 2009

Case: A 62 year old male with past medical history of diabetes mellitus, hyperlipidemia, atrial fibrillation, hypertension, and mild renal insufficiency - presented to ER with severe weakness, anuria and renal failure. Patient report extremely dark urine for few days prior to presentation. Patient was discharged 5 weeks ago from hospital with Aspirin, Coumadin, Lopressor, Amiodarone and simvastatin . Laboratory workup in ED showed creatine kinase (CK) in 80,000 U/L range. BUN 65 mg/dL, creatinine 4.6 mg/dL. Liver function test (LFT) are also moderately elevated. What could be the reason of of this life threatening Rhabdomyolysis?


Answer: Simvastatin-Amiodarone Interaction

Simvastatin is metabolized primarily by CYP3A4, and amiodarone is a recognized inhibitor of this enzyme. This drug interaction may cause severe life threatening Rhabdomyolysis. The risk is higher in patients, particularly with simvastatin doses greater than 20 mg daily.


Reference: Click to get abstract

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