Simvastatin-fluconazole causing rhabdomyolysis

Aasma Shaukat, Mustafa Benekli, Georgirene D. Vladutiu, James L Slack, Meir Wetzler, Maria R. Baer

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

OBJECTIVE: To report a case of rhabdomyolysis after concomitant use of simvastatin, a commonly used hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, and fluconazole, an azole antifungal agent. CASE SUMMARY: An 83-year-old white man with a history of congestive heart failure and hyperlipidemia presented to the hospital 1 week following the addition of fluconazole to a medication regimen that included simvastatin 40 mg once daily. The patient had severe muscle weakness and a markedly elevated serum creatine kinase activity, which resolved following discontinuation of simvastatin and fluconazole. DISCUSSION: Rhabdomyolysis is a recognized adverse effect of HMG-CoA reductase inhibitors (statins), commonly caused by their interaction with other drugs, such as azole antifungals, that inhibit the cytochrome P450 isoenzyme family. An objective causality assessment revealed that the adverse drug event was probable. Although drug interactions have been described for combinations of other HMG-CoA reductase inhibitors and azole antifungals, rhabdomyolysis likely caused by the interaction between simvastatin and fluconazole has not yet been reported. This case reinforces the importance of being vigilant for drug interactions, particularly in connection with commonly prescribed medications such as statins. CONCLUSIONS: Patients receiving statins who have cancer may receive azole antifungals and other drugs that inhibit CYP3A4 during treatment, predisposing them to toxicity. These patients should therefore be monitored closely for drug interactions.

Original languageEnglish (US)
Pages (from-to)1032-1035
Number of pages4
JournalAnnals of Pharmacotherapy
Volume37
Issue number7-8
StatePublished - Jul 2003
Externally publishedYes

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Rhabdomyolysis
Simvastatin
Fluconazole
Azoles
Drug Interactions
Oxidoreductases
Cytochrome P-450 CYP3A
Antifungal Agents
Muscle Weakness
Creatine Kinase
Hyperlipidemias
Drug-Related Side Effects and Adverse Reactions
Causality
Pharmaceutical Preparations
Cytochrome P-450 Enzyme System
Isoenzymes
Heart Failure
Serum
Neoplasms

Keywords

  • Fluconazole
  • HMG-CoA reductase inhibitors
  • Rhabdomyolysis
  • Simvastatin

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Shaukat, A., Benekli, M., Vladutiu, G. D., Slack, J. L., Wetzler, M., & Baer, M. R. (2003). Simvastatin-fluconazole causing rhabdomyolysis. Annals of Pharmacotherapy, 37(7-8), 1032-1035.

Simvastatin-fluconazole causing rhabdomyolysis. / Shaukat, Aasma; Benekli, Mustafa; Vladutiu, Georgirene D.; Slack, James L; Wetzler, Meir; Baer, Maria R.

In: Annals of Pharmacotherapy, Vol. 37, No. 7-8, 07.2003, p. 1032-1035.

Research output: Contribution to journalArticle

Shaukat, A, Benekli, M, Vladutiu, GD, Slack, JL, Wetzler, M & Baer, MR 2003, 'Simvastatin-fluconazole causing rhabdomyolysis', Annals of Pharmacotherapy, vol. 37, no. 7-8, pp. 1032-1035.
Shaukat A, Benekli M, Vladutiu GD, Slack JL, Wetzler M, Baer MR. Simvastatin-fluconazole causing rhabdomyolysis. Annals of Pharmacotherapy. 2003 Jul;37(7-8):1032-1035.
Shaukat, Aasma ; Benekli, Mustafa ; Vladutiu, Georgirene D. ; Slack, James L ; Wetzler, Meir ; Baer, Maria R. / Simvastatin-fluconazole causing rhabdomyolysis. In: Annals of Pharmacotherapy. 2003 ; Vol. 37, No. 7-8. pp. 1032-1035.
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