Amiodarone/atorvastatin/ciprofloxacin interaction
- PDF / 170,725 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 64 Downloads / 152 Views
1 XS
Rhabdomyolysis due to drug interactions: case report A 55-year-old man developed rhabdomyolysis due to pharmacokinetic drug interactions between atorvastatin, amiodarone and ciprofloxacin [not all routes stated]. The man, who presented with anterior ST-elevation myocardial infarction, was hospitalised due to requirement of percutaneous coronary intervention. His medical history was significant for type 2 diabetes. On admission day 1, atorvastatin 80mg daily was initiated. Thereafter, he underwent implantation of a left-ventricular assist device. On admission day 8, he started receiving oral amiodarone 400mg thrice a day due to post-operative atrial fibrillation [aetiology of atrial fibrillation not stated]. On admission day 14, oral ciprofloxacin 750mg, twice a day was also initiated for Klebsiella oxytoca ventilator-associated pneumonia (VAP). On admission day 17 of hospitalisation, the LDH was found to be 1382 U/L and the colour of his urine was dark amber. The physical examination revealed no signs of compartment syndrome. Laboratory investigations revealed elevated creatine kinase (CK) and serum creatinine levels. The urine myoglobin was >500000 µg/L. Eventually, he was diagnosed with rhabdomyolysis. The man was thus hydrated with IV fluids. Upon review of medicinal history, it was noted that the last dose of atorvastatin was administered on admission day 16, five days ciprofloxacin therapy was completed on day 18 of hospitalisation and on admission day 19, amiodarone was also stopped as he attained stable sinus rhythm. Atorvastatin was not administered thereafter. His condition resolved following cessation of these drugs. Additionally, the CK values also normalised. It was later determined that, the rhabdomyolysis might have caused due to inhibition of atorvastatin metabolism, which might have resulted due to pharmacokinetic drug-drug interactions between atorvastatin (a CYP3A4 substrate) and the CYP3A4 inhibitors i.e., amiodarone and ciprofloxacin. The man was re-challenged with amiodarone and a non–CYP-mediated statin, pravastatin. He remained stable thereafter with no recurrence of interaction and rhabdomyolysis. The Naranjo scale score (score:5) indicated that the association between atorvastatin and rhabdomyolysis was ’probable’; while as per the Drug Interaction Probability Scale, a ’possible’ relation was assessed between CYP3A4-mediated drug interactions and rhabdomyolysis. Cowley E, et al. Suspected Drug-Induced Rhabdomyolysis From the Combination of Atorvastatin, Amiodarone, and Ciprofloxacin. Annals of Pharmacotherapy : 7 Aug 2020. 803498856 Available from: URL: http://doi.org/10.1177/1060028020946299
0114-9954/20/1819-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 29 Aug 2020 No. 1819
Data Loading...
