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

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    Authors
    Magee, Ciara N
    Medani, Samar A
    Leavey, Sean F
    Conlon, Peter J
    Clarkson, Michael R
    Affiliation
    Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
    Issue Date
    2010-11
    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
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    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
    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
    ISSN
    1523-6838
    ae974a485f413a2113503eed53cd6c53
    10.1053/j.ajkd.2010.07.011
    Scopus Count
    Collections
    Beaumont Hospital

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