Atorvastatin/ciprofloxacin interaction
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Myopathy: case report A 65-year-old woman developed myopathy following concomitant use of atorvastatin and ciprofloxacin [routes not stated; not all durations of treatments to reaction onset stated]. The woman, who was initially seen for urinary complaints, had started receiving ciprofloxacin. She developed extreme fatigue, agitation, progressing muscle weakness and insomnia. Due to worsening of her condition, her family privately consulted a general practitioner for an advice in May 2018. She had a history of coronary artery disease and was receiving treatment with atorvastatin 80 mg/day and concomitant bisoprolol, aspirin, ticagrelor and perindopril. She presented with a short history of diffuse muscle pain and bilateral leg muscle weakness, which had increased progressively. Almost a week prior to the presentation, she had started receiving a 5-day course of ciprofloxacin 500mg twice a day for urinary frequency and urgency. Her remaining drug regimen had been stable, and she had not used other over-the-counter drugs or herbal products. Prior to starting ciprofloxacin, her serum creatinine level was 0.58 mg/dL. She developed agitation, insomnia and restlessness a day after starting ciprofloxacin. Also, she had muscle aches with muscle weakness in the limbs, which worsened over time. She had progressive difficulty in performing the daily activities. She required assistance in getting out of bed. Her limb weakness progressed as the antibiotic course was continued. Her limb weakness progressed to the point that she could not keep her balance and had a fall while walking causing injury to her limbs and face. She was advised to continue the treatment. The woman received treatment with risperidone 1mg for insomnia and agitation. However, her condition did not improve, and her weakness increased to point that the she was unable to walk without support, causing her to seek medical advice from other doctors in the community. Her family physician advised to seek immediate care, and she was referred in April 2018 for further evaluation. On presentation, her physical examination revealed reduced power, especially in the lower limbs. Her creatinine kinase was found to be slightly elevated at 183 U/L. Thus, a provisional diagnosis of statin-induced myopathy due to interaction with ciprofloxacin was made. The primary treating physician was informed about the probable drug interaction, and her treatment with atorvastatin and ciprofloxacin was discontinued. Muscle weakness resolved over a period of time, and she showed a significant clinical improvement and was able to walk initially with the support of a Zimmer frame and within a period of 3 weeks, could independently perform daily activities. Her creatinine kinase became normal within a few weeks. Thus, a final diagnosis of drug interaction-induced myopathy due to atorvastatin and ciprofloxacin was made. Atorvastatin was restarted after a month [outcome after re-challenge not stated]. Irfan F, et al. Co-prescription of ciprofloxacin and statins; A dangerous combination: C
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