Canagliflozin/rosuvastatin interaction
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Rhabdomyolysis and hepatocellular injury: case report A 76-year-old woman developed rhabdomyolysis and hepatocellular injury following the concomitant administration of rosuvastatin and canagliflozin for coronary artery disease and type-2-diabetes, respectively [routes not stated]. The woman presented to the hospital with new-onset muscle pain and difficulty in ambulating (current presentation). Her medical history was significant for coronary artery disease, stage III B chronic kidney disease and type-2-diabetes. She had been receiving rosuvastatin 40mg daily for more than 5 years and had tolerated the therapy well. Her other ongoing medications included bisoprolol, aspirin [acetylsalicylic acid], metformin, levothyroxine-sodium [L-thyroxine] and risedronic-acid [risedronate]. During anamnesis, it was revealed that 15 days prior to the current presentation, canagliflozin 100mg daily was started and no other changes were made to her ongoing medications regimen. The initial symptoms (bilateral thigh pain and weakness) developed three days after canagliflozin initiation. The symptoms worsened in the following days and progressed to involve the upper extremities. At the time of current presentation, marked muscle weakness was noted and she was able to walk with assistance only. Laboratory examination revealed the following: creatinine kinase 13262 U/L (indicating rhabdomyolysis), ALT 1017 U/L, AST 1126 U/L and bilirubin 6 µmol/L (indicating hepatocellular injury) with thyroid stimulating hormone 6.82 mIU/L, and creatinine 194 µmol/L (baseline level 150 µmol/L). She tested negative for CRP, antinuclear antibodies or antibodies directed against extractable nuclear antigens. Further tests showed elevated plasma rosuvastatin level at 176 ng/mL (15 times more than the expected levels). Consequently, rhabdomyolysis and hepatocellular injury related to a pharmacokinetic interaction between rosuvastatin and canagliflozin was considered. The woman’s rosuvastatin and canagliflozin therapies were stopped. She was administered IV crystalloid. Subsequently, her muscle pain subsided and weakness improved. After 10 days, she was discharged. At the time of discharge, she was ambulating with a walker and all laboratory parameters were nearly normal. Brailovski E, et al. Rosuvastatin Myotoxicity After Starting Canagliflozin Treatment: A Case Report. Annals of Internal Medicine : no pagination, 4 Aug 2020. Available 803499247 from: URL: http://doi.org/10.7326/L20-0549
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Reactions 5 Sep 2020 No. 1820
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