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Rhabdomyolysis following drug interaction: case report A 66-year-old man developed rhabdomyolysis following concurrent administration of abiraterone-acetate, simvastatin, and amlodipine for metastatic castration resistant prostate cancers, mild hyperlipidemia and hypertension, respectively [not all dosages, routes, duration of treatments to reaction onset and outcomes stated]. The man, who had metastatic castration resistant prostate cancers (mCRPCs), started receiving abiraterone-acetate [Zytiga] 1000mg and prednisone 3 months before hospitalisation. His condittion progressed on enzalutamide, which was started for progressive disease after surgical castration. He was on vacation after initiating a regimen of abiraterone-acetate and low-dose prednisone. He returned home as he had increasing jaundice. He presented to the hospital with lower limb weakness, gait difficulty, light colored stool, itching, and increasing jaundice. He denied any bladder or bowel incontinence. His medications included amlodipine 5mg daily, metoprolol for hypertension (started before 3 years) and simvastatin 20mg daily for mild hyperlipidemia (started 40mg before 6-7 years, but he reduced the dose to 20mg before 3 years). Physical examination revealed deep icterus and lower limb weakness. His hip flexion and extension were noted to be 3/5 bilaterally and knee extension and flexion were 4/5. Babinski and deep tendon reflexes were normal. His sensation was intact in bilateral lower extremities. His laboratory investigation revealed elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin, direct bilirubin, and creatinine kinase (CK). His CK level was at peak on day 3 of admission and decreased on day 7. MRI studies revealed biliary obstruction and liver metastases. Based on the investigational results, rhabdomyolysis was considered finally. The man was treated with aggressive IV fluids for rhabdomyolysis and abiraterone-acetate and simvastatin were discontinued. On discharge, his CK level was 589 U/L. His weakness improved with physical therapy. Biliary obstruction was relieved by biliary sphincterotomy and biliary stent placement of the common bile duct and pancreatic duct on day 12. His AST, ALT, ALP, and bilirubin levels were found to be declined on day 21. Cytology and biopsy of the common bile duct were negative for malignant cells. He then received treatment with docetaxel [Taxotere] for mCRPC on account of disease progression on enzalutamide and abirateroneacetate. It was noted that, he had increasing prostate-specific antigen levels on docetaxel and thus, treatment with docetaxel was switched to cabazitaxel. Mutational profiling on peripheral blood and tissue was performed to detect any mutation that could be targeted. Desikan SP, et al. Statin-Induced Rhabdomyolysis Due to Pharmacokinetic Changes From Biliary Obstruction in a Patient With Metastatic Prostate Cancer. Journal of 803499048 Investigative Medicine High Impact Case Reports 8: Jan 2020. Available from: URL: