Atorvastatin interaction
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First report of an interaction with concomitant colchicine leading to rhabdomyolysis: case report A 45-year-old man developed rhabdomyolysis during concomitant treatment with colchicine for amyloidosis and atorvastatin for hypercholesterolaemia. The man, who had been receiving theophylline and colchicine (1.5 mg/day) for 3 years, started receiving atorvastatin 10 mg/day. After 2 weeks, he experienced progressive weakness of his lower extremities, muscle pain and instability of gait. His symptoms worsened, and he developed altered mentation and severe fatigue several days before admission. He was hospitalised with dyspnoea, altered mentation and severe fatigue 1 month after atorvastatin initiation. On examination, he had a HR of 110 beats/min and a respiratory rate of 30 breaths/min; he was confused, had bilateral fine crackles in his lungs, a barrel-shaped chest, moderate peripheral oedema and dark urine. Blood tests and urinalysis revealed leucocytosis and myoglobinuria. He had an oliguric acute renal failure, electrolyte disturbances and hypervolaemia. The man received haemodialysis and ventilatory support and his mental condition subsequently improved. On neurological examination relaxation in his deep-tendon reflexes was slightly delayed and he had a marked symmetrical proximal muscle weakness especially in his lower extremities (Medical Research Council Scale grade 2/5 and 3/5 for his lower and upper limbs, respectively). At admission, his creatine kinase (CK) and myoglobin levels were 9035 U/L (reference range 30–170) and > 3000 ng/mL (0–72), respectively. He also had myoglobinuric acute oliguric renal failure. He was diagnosed with rhabdomyolysis associated with the concomitant use of colchicine and atorvastatin; both drugs were discontinued; 10 days after admission, his CK and myoglobin levels were 1029 U/L and 995 ng/mL, respectively and his muscle strength improved. Subsequently, he became dependent on haemodialysis, developed septic shock due to nosocomial pneumonia, and died of refractory septic shock and respiratory failure on hospital day 18. Author comment: "Use of the Naranjo probability scale indicated a probable relationship between rhabdomyolysis and concomitant atorvastatin-colchicine therapy. . . Our patient’s rhabdomyolysis was probably caused by the interaction of atorvastatin and colchicine." Tufan A, et al. Rhabdomyolysis in a patient treated with colchicine and atorvastatin. Annals of Pharmacotherapy 40: 1466-1469, No. 7-8, Jul-Aug 2006 801013635 Turkey
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of an interaction between atorvastatin and colchicine. The WHO Adverse Drug Reactions database contained 681 reports involving the concomitant use of atorvastatin and colchicine.
0114-9954/10/1118-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 9 Sep 2006 No. 1118
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