Atorvastatin/paracetamol interaction
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Drug-induced toxic hepatitis and rhabdomyolysis: case report A 48-year-old man developed drug-induced toxic hepatitis and rhabdomyolysis following concomitant administration of atorvastatin with paracetamol [routes, times to reaction onsets and outcomes not stated]. The man sought independent advice from a doctor on 01 May 2015 due to a worsening of his condition on the 7th day from the onset of the disease with complaints of severe weakness, bruising and pain in muscles, disorientation in space, almost complete lack of appetite, nausea, loose stools without impurities 3-4 times a day. On anamnesis, he revealed that he fell ill 7 days prior to this presentation with an increase in body temperature up to 39°C, headache and dry cough. He independently took paracetamol up to 3 tablets per day (total dose 1500 mg/day). His medical history was significant for an acute myocardial infarction, for which he had undergone coronary artery bypass and grafting 3 years ago. His concomitent medications included atorvastatin 40mg daily, clopidogrel 75mg daily, candesartan 8mg daily and bisoprolol 5mg daily. He did not had any contacts with infectious patients, and he did not go to areas with unfavourable epidemiological situation for 3 years. His social and living conditions were satisfactory. He occasionally consumed alcoholic beverages in a dose of 0.2–0.5 litres. He smoked 8-10 cigarettes a day for over 30 years. On the 1st day after the onset of the disease, he underwent various clinical examinations and was diagnosed with acute respiratory viral infection by a physician at the place of residence. On the 2nd day after the onset of the disease, he tested positive for influenza. Taking into account the positive dynamics, the therapy was left in the same volume. On the 4th day after the onset of the disease, his condition worsened. He thus underwent further examination and was diagnosed with right-sided pneumonia. He was detected with Streptococcus pneumoniae. He then started receiving linezolid for up to 10 days, ambroxol and paracetamol with an increase in body temperature above 38.0°C and pain syndrome. He continued receiving previously prescribed therapy. After 3 days (i.e., on the 7th day from the onset of the disease), body temperature did not exceed 36.8°C, and the cough decreased. However, his general condition deteriorated sharply and new issues appeared. Thus, he sought independent consultation with a specialist. Clinical examination revealed the following: serious condition, body temperature 36.5°C, RR 18 breaths/minute, HR 108 beats/minute and BP 94/62mm Hg. Pharynx had no peculiarities. During pulmonary auscultation, hard breathing was heard in all sections, a small amount of dry wheezing was noted on the right below the angle of the scapula. The abdomen was soft, soreness on superficial palpation, the liver protrudes from under the edge of the costal arch by 1cm. Laboratory examination revealed the following: AST 1250 U/L, ALT 1470 U/L, creatine phosphokinase 1180 U/L, total bilirubin 45 µmol/L, negative HBsAg
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