Atorvastatin
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Atorvastatin Various toxicities: 2 case reports
In a case report, two patients a 68-year-old man and a 62-year-old woman were described, out of which, the man developed rhabdomyolysis and bladder cancer, while the woman developed hepatotoxicity, rash and diarrhoea during treatment with atorvastatin for acute myocardial infarction or high cholesterol [routes not stated; not all durations of treatments to reactions onsets stated]. Case 1: A 68-year-old man was admitted with complaints of severe pain in the muscles of the lower extremities, general weakness, impeded movement, a feeling of weakness and an increase in body temperature to subfebrile. Over the past two months, a deterioration in his well-being was noted, as weakness and pain slowly began to increase. A week before the hospitalisation, he had stopped moving independently. His medical records showed that he had arterial hypertension for 23 years and was hospitalised several times. A high level of cholesterol, was detected 26 months ago and thus he started receiving atorvastatin 20 mg/day. After which he had above complaints. Eventually, atorvastatin was stopped. Based on the results of an outpatient myographic study, reliable signs of progressive primary muscle damage were revealed along with moderate leukocytosis, an increase in the ESR and a moderate increase in fibrinogen. The concentration of atorvastatin was 85 mg/mL. Myoglobin level in the blood serum was 5,238 ng/mL. Based on the clinical picture and the results of the myographic examination, he was diagnosed with statin-induced rhabdomyolysis. To identify the cause of statin-induced myopathy, a pharmacogenetic study was performed, which revealed that he was a carrier of polymorphism in the organic anion transporter gene SLCO1B1. Then, he was prescribed the antioxidant ethoxidol. His condition improved, and the severity of the myopathy symptoms decreased. The third cause of myopathy, in connection with the appearance of dysuria was a malignant tumour. Subsequently, he underwent surgery. The assumption was raised that there was a connection between the use of statins and occurrence of bladder cancer. Case 2: A 62-year-old woman after experiencing acute myocardial infarction started receiving atorvastatin 80mg in the evening along with aspirin [acetylsalicylic acid], ticagrelor, carvedilol, enalapril, omeprazole and spironolactone. On the day 14 of therapy, she developed a rash and experienced diarrhoea. On the day 19, she had a low-grade fever, a feeling of bitterness in the mouth, aversion to food and nausea. On the day 30, she was admitted to the hospital. Laboratory investigations showed elevated levels of ALT and AST levels. Various other tests were performed. Atorvastatin was discontinued and received infusion therapy with ornithine-aspartate [hepa-merz] and heptral. Her condition improved on the day 2, as AST and ALT levels decreased. She was then transferred to the Center for Personalized Medicine (CPM). On genotyping, it was determined that, she had the genotype s.521tt as per the polymo
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