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Atorvastatin/verapamil Elevated hepatic transaminases, decreased blood cholesterol and pain in right hypochondrium: 8 case reports

In a retrospective study of 76 patients treated between 2015–2018 in I.V. Davydovsky City Clinical Hospital of Russia, 8 patients [including 1 woman aged 61 years; not all ages and sexes stated] were described, who developed elevated levels of ALT and AST or excessive decrease in blood cholesterol levels during treatment with atorvastatin for hyperlipidaemia. Additionally, the woman developed pain in the right hypochondrium following a concomitant administration of atorvastatin and verapamil [not all indications and outcomes stated; routes and duration of treatments to reaction onsets not stated]. The patients, who had hyperlipidaemia, had been receiving atorvastatin 20–40 mg/day for more than 6 months. Subsequently, the patients developed elevated levels of ALT and AST (7 patients), and elevated levels of ALT and AST and excessive decrease in blood cholesterol levels (1 woman) secondary to atorvastatin therapy. The ALT level ranged between 21–304 U/L and AST between 33–275 U/L. Of the 8 patients, the woman had been concomitantly receiving verapamil 80mg three times a day. Subsequently, she developed a pain in right hypochondrium that was attributed to verapamil and atorvastatin interaction. The woman’s treatment with atorvastatin was stopped. Three days following the treatment discontinuation, the level of ALT and AST decreased by 1.5 times and the pain in the hypochondrium also resolved. Kazakov RYe, et al. Pharmacogenetic approaches to enhancing efficacy and safety of statins as illustrated by the example of atorvastatin. [Russian]. Safety and Risk of 803502387 Pharmacotherapy 8: 43-51, No. 1, 2020. Available from: URL: http://doi.org/10.30895/2312-7821-2020-8-1-43-51 [Russian; summarised from a translation]

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Reactions 26 Sep 2020 No. 1823