Case Report

Recovery Time in a Case of Gemfibrozil and Simvastatin-Associated Rhabdomyolysis

Authors: Dosha Cummins PharmD, BCPS, Michael Mackey MD, Erica Baker DO

Abstract

Abstract:Simvastatin is a cholesterol-lowering medication heavily prescribed to treat and prevent vascular disease. Despite widespread use, cases of simvastatin-induced rhabdomyolysis are rare. Little information is available regarding the recovery period for a patient who has experienced drug-induced rhabdomyolysis. We present a case involving a patient with multiple risk factors (advanced age, high-dose simvastatin therapy, concomitant nonsteroidal anti-inflammatory medication, and concomitant gemfibrozil therapy) and highlight his recovery course.

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References

References1. Marais GE, Larsen KK. Rhabdomyolysis and acute renal failure induced by combination lovastatin and gemfibrozil therapy. Ann Intern Med 1990;112:228–230.MaraisGE]]LarsenKKRhabdomyolysis and acute renal failure induced by combination lovastatin and gemfibrozil therapy.Ann Intern Med1990112228-2302. Pierce LR, Wysowski DK, Gross TP. Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy. JAMA 1990;264:71–75.PierceLR]]WysowskiDK]]GrossTPMyopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy.JAMA199026471-753. van Puijenbroek EP, Du Buf-Vereijken PW, Spooren PF, et al. Possible increased risk of rhabdomyolysis during concomitant use of simvastatin and gemfibrozil. J Intern Med 1996;240:403–404.van PuijenbroekEP]]Du Buf-VereijkenPW]]SpoorenPF&etal;Possible increased risk of rhabdomyolysis during concomitant use of simvastatin and gemfibrozil.J Intern Med1996240403-4044. Tal A, Rajeshawari M, Isley W. Rhabdomyolysis associated with simvastatin-gemfibrozil therapy. South Med J 1997;90:546–547.TalA]]RajeshawariM]]IsleyWRhabdomyolysis associated with simvastatin-gemfibrozil therapy.South Med J199790546-5475. Duell PB, Connor WE, Illingworth DR. Rhabdomyolysis after taking atorvastatin with gemfibrozil. Am J Cardiol 1998;81:368–369.DuellPB]]ConnorWE]]IllingworthDRRhabdomyolysis after taking atorvastatin with gemfibrozil.Am J Cardiol199881368-3696. Graham DJ, Staffa JA, Shatin D, et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA 2004;292:2585–2590.GrahamDJ]]StaffaJA]]ShatinD&etal;Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs.JAMA20042922585-25907. Backman JT, Kyrklund C, Kivistö KT, et al. Plasma concentrations of active simvastatin acid are increased by gemfibrozil. Clin Pharmacol Ther 2000;68:122–129.BackmanJT]]KyrklundC]]KivistöKT&etal;Plasma concentrations of active simvastatin acid are increased by gemfibrozil.Clin Pharmacol Ther200068122-1298. Pasternak RC, Smith SC Jr, Bairey-Merz CN, et al; American College of Cardiology; American Heart Association; National Heart, Lung and Blood Institute. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Stroke 2002;33:2337–2341.PasternakRC]]SmithSCJr]]Bairey-MerzCN&etal;American College of CardiologyAmerican Heart AssociationNational Heart, Lung and Blood InstituteACC/AHA/NHLBI clinical advisory on the use and safety of statins.Stroke2002332337-23419. Antons KA, Williams CD, Baker SK, et al. Clinical perspectives of statin-induced rhabdomyolysis. Am J Med 2006;119:400–409.AntonsKA]]WilliamsCD]]BakerSK&etal;Clinical perspectives of statin-induced rhabdomyolysis.Am J Med2006119400-40910. Lamb E. Top 200 prescription drugs of 2007. Pharmacy Times. May 2008.11. Zocor (Simvastatin) [Package Insert]. Whitehouse Station, NJ, Merck & Co, Inc, 2008.12. National Heart, Lung, and Blood Institute, National Institutes of Health. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, MD, National Heart, Lung, and Blood Institute, National Institutes of Health, September 2002.13. Roberts LJ, Morrow JD. Analgesic-Antipyretics and Anti-Inflammatory Agents and Drugs Employed in the Treatment of Gout, in Hardman JG, Limbird LE, Gilman AG (eds): Goodman & Gilman's The Pharmacological Basis of Therapeutics. New York, McGraw Hill, 2001, p 695.RobertsLJ]]MorrowJDAnalgesic-Antipyretics and Anti-Inflammatory Agents and Drugs Employed in the Treatment of Gout, in Hardman JG, Limbird LE, Gilman AG (eds): Goodman & Gilman's The Pharmacological Basis of Therapeutics.New YorkMcGraw Hill200169514. Cardiovascular Disease Risk Reduction, Adults Cholesterol Guidelines Update, ATP IV Hypertension Guidelines Update, JNC 8, Obesity Guidelines Update, Adults. Available at: http://www.nhlbi.nih.gov/guidelines/cvd_adult/background.htm. Accessed June 23, 2009.