Atorvastatin/colchicine interaction
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Toxic myopathy and acute deterioration of renal function: case report A 94-year-old man developed severe toxic myopathy and mild acute deterioration of renal function following the concomitant administration of atorvastatin for dyslipidaemia and colchicine for an episode of gouty arthritis [routes and time to reactions onsets not stated]. The man presented due to tetraparesis (predominantly in the lower limbs and proximal musculature) after treatment with atorvastatin and colchicine. Tetraparesis had exacerbated in the week before presentation, in which he had lost his autonomous ambulation. He had a history of dyslipidaemia, chronic renal failure and type 2 diabetes mellitus. He had been receiving atorvastatin 40 mg/day for 5 years. One month prior to consulation, he had also started receiving colchicine 0.5 mg/day for an episode of gouty arthritis. On presentation, investigations revealed elevated creatine kinase levels and mild acute deterioration of renal function. Electromyographic study revealed an irritative myopathic pattern with electrical myotonia, and the muscle biopsy showed common fibres with sarcoplasmic vacuoles without basophilic ribbon and with a slight increase in acid phosphatase activity, with no necrosis or inflammatory infiltrates. There was overexpression of major histocompatibility complex I in the muscle fibre sarcolemma and deposition of complement membrane attack complex (C5b9) in the endomysial capillaries. Ultrastructural study showed muscle fibres with single-membrane vacuoles with cellular debris and membrane material inside. Screening for autoimmune diseases and the determination of anti-HMG-CoA reductase antibodies were negative. A diagnosis of toxic myopathy and acute deterioration of renal function due to pharmacokinetic interaction between atorvastatin and colchicine was made. The man’s therapy with atorvastatin was stopped. He had already stopped colchicine on the day prior to presentation. A decrease in creatine kinase levels by half was observed in the first 48 hours of atorvastatin and colchicine discontinuation. The creatine kinase levels normlaised at day 5 of atorvastatin and colchicine discontinuation. Creatinine levels normalised 1 week after the discontinuation of atorvastatin and colchicine. Clinically, he showed progressive motor improvement over the following months; however, mild proximal weakness persisted in the lower limbs. Sanchez-Tejerina San Jose D, et al. [Toxic myopathy associated with concomitant treatment with atorvastatin and colchicine]. Revista de Neurologia 68: 488-489, No. 11, Jun 803503915 2019. Available from: URL: http://doi.org/10.33588/rn.6811.2018439 [Spanish; summarised from a translation]
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Reactions 26 Sep 2020 No. 1823
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