Severe rhabdomyolysis as a consequence of the interaction of fusidic acid and atorvastatin.

Hdl Handle:
http://hdl.handle.net/10147/126141
Title:
Severe rhabdomyolysis as a consequence of the interaction of fusidic acid and atorvastatin.
Authors:
Magee, Ciara N; Medani, Samar A; Leavey, Sean F; Conlon, Peter J; Clarkson, Michael R
Affiliation:
Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
Citation:
Severe rhabdomyolysis as a consequence of the interaction of fusidic acid and atorvastatin. 2010, 56 (5):e11-5 Am. J. Kidney Dis.
Journal:
American journal of kidney diseases : the official journal of the National Kidney Foundation
Issue Date:
Nov-2010
URI:
http://hdl.handle.net/10147/126141
DOI:
10.1053/j.ajkd.2010.07.011
PubMed ID:
20888103
Abstract:
Rhabdomyolysis is a known complication of statin therapy and may be triggered by a pharmacokinetic interaction between a statin and a second medication. Fatal statin-induced rhabdomyolysis has an incidence of 0.15 deaths/million prescriptions. We describe 4 cases of severe rhabdomyolysis with the common feature of atorvastatin use and coadministration of fusidic acid. All cases involved long-term therapy with atorvastatin; fusidic acid was introduced for treatment of osteomyelitis or septic arthritis. Three cases occurred in the setting of diabetes mellitus, with 2 in patients with end-stage renal disease, suggesting increased susceptibility to atorvastatin-fusidic acid-induced rhabdomyolysis in these patient populations. Of the 4 patients in this series, 3 died. Fusidic acid is a unique bacteriostatic antimicrobial agent with principal antistaphylococcal activity. There have been isolated reports of rhabdomyolysis attributed to the interaction of statins and fusidic acid, the cause of which is unclear. Fusidic acid does not inhibit the cytochrome P450 3A4 isoenzyme responsible for atorvastatin metabolism; increased atorvastatin levels due to inhibition of the glucuronidation pathway may be responsible. Considering the low frequency of fusidic acid use, the appearance of 4 such cases within a short time and in a small population suggests the probability that development of this potentially fatal complication may be relatively high.
Item Type:
Article
Language:
en
MeSH:
Aged; Anti-Bacterial Agents; Arthritis, Infectious; Drug Interactions; Drug Therapy, Combination; Follow-Up Studies; Fusidic Acid; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Osteomyelitis; Pyrroles; Rhabdomyolysis; Severity of Illness Index
ISSN:
1523-6838

Full metadata record

DC FieldValue Language
dc.contributor.authorMagee, Ciara Nen
dc.contributor.authorMedani, Samar Aen
dc.contributor.authorLeavey, Sean Fen
dc.contributor.authorConlon, Peter Jen
dc.contributor.authorClarkson, Michael Ren
dc.date.accessioned2011-03-29T15:11:57Z-
dc.date.available2011-03-29T15:11:57Z-
dc.date.issued2010-11-
dc.identifier.citationSevere rhabdomyolysis as a consequence of the interaction of fusidic acid and atorvastatin. 2010, 56 (5):e11-5 Am. J. Kidney Dis.en
dc.identifier.issn1523-6838-
dc.identifier.pmid20888103-
dc.identifier.doi10.1053/j.ajkd.2010.07.011-
dc.identifier.urihttp://hdl.handle.net/10147/126141-
dc.description.abstractRhabdomyolysis is a known complication of statin therapy and may be triggered by a pharmacokinetic interaction between a statin and a second medication. Fatal statin-induced rhabdomyolysis has an incidence of 0.15 deaths/million prescriptions. We describe 4 cases of severe rhabdomyolysis with the common feature of atorvastatin use and coadministration of fusidic acid. All cases involved long-term therapy with atorvastatin; fusidic acid was introduced for treatment of osteomyelitis or septic arthritis. Three cases occurred in the setting of diabetes mellitus, with 2 in patients with end-stage renal disease, suggesting increased susceptibility to atorvastatin-fusidic acid-induced rhabdomyolysis in these patient populations. Of the 4 patients in this series, 3 died. Fusidic acid is a unique bacteriostatic antimicrobial agent with principal antistaphylococcal activity. There have been isolated reports of rhabdomyolysis attributed to the interaction of statins and fusidic acid, the cause of which is unclear. Fusidic acid does not inhibit the cytochrome P450 3A4 isoenzyme responsible for atorvastatin metabolism; increased atorvastatin levels due to inhibition of the glucuronidation pathway may be responsible. Considering the low frequency of fusidic acid use, the appearance of 4 such cases within a short time and in a small population suggests the probability that development of this potentially fatal complication may be relatively high.-
dc.language.isoenen
dc.subject.meshAged-
dc.subject.meshAnti-Bacterial Agents-
dc.subject.meshArthritis, Infectious-
dc.subject.meshDrug Interactions-
dc.subject.meshDrug Therapy, Combination-
dc.subject.meshFollow-Up Studies-
dc.subject.meshFusidic Acid-
dc.subject.meshHeptanoic Acids-
dc.subject.meshHumans-
dc.subject.meshHydroxymethylglutaryl-CoA Reductase Inhibitors-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshOsteomyelitis-
dc.subject.meshPyrroles-
dc.subject.meshRhabdomyolysis-
dc.subject.meshSeverity of Illness Index-
dc.titleSevere rhabdomyolysis as a consequence of the interaction of fusidic acid and atorvastatin.en
dc.typeArticleen
dc.contributor.departmentDepartment of Nephrology, Beaumont Hospital, Dublin, Ireland.en
dc.identifier.journalAmerican journal of kidney diseases : the official journal of the National Kidney Foundationen
dc.description.provinceLeinster-

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