Case Report

Rhabdomyolysis Associated with Simvastatin-Nefazodone Therapy

Authors: Maryann Z. Skrabal, PHARMD, CDE, Julie A. Stading, PHARMD, Michael S. Monaghan, PHARMD

Abstract

Simvastatin is a hydroxymethyl glutaryl coenzyme A reductase inhibitor commonly used to treat patients with hyperlipidemia. It is a safe and effective medication in most patients when used appropriately. A serious side effect known as rhabdomyolysis may rarely occur in patients who take simvastatin, especially at higher doses and with agents that interact and increase the level of simvastatin in the blood. We describe the case of a patient with rhabdomyolysis that occurred after the patient's simvastatin was titrated to 80 mg at approximately the same time that his antidepressant medication was switched to nefazodone. We found only two other similar cases in the literature, both of which were presented as letters to the editor in two different journals. We present this case to add to the literature and to assist practitioners by raising their awareness of this interaction so that it can be monitored.

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References

1. Omar MA, Wilson JP, Cox TS. Rhabdomyolysis and HMG-CoA reductase inhibitors. Ann Pharmacother 2001; 55: 1096–1105.
2. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995; 52: 1639–1645.
 
3. Elick K, Sprague JE. Renal and muscle damage induced by the statins. Pharmacy Times 2001; 67: 22–25.
 
4. Bottorff M, Hansten P. Long-term safety of hepatic hydroxymethyl glutaryl coenzyme A reductase inhibitors. Arch Intern Med 2000; 160: 2273–2280.
5. Davidson MH. Safety profiles for the HMG-CoA reductase inhibitors: Treatment and trust. Drugs 2001; 61: 197–206.
6. White CM. An evaluation of CYP3A4 drug interactions with HMG-CoA reductase inhibitors. Formulary 2000; 35: 343–352.
7. Jacobsen RH, Wang P, Glueck CJ. Myositis and rhabdomyolysis associated with concurrent use of simvastatin and nefazodone. JAMA 1997; 277: 296–297 (letter).
8. Thompson M, Samuels S. Rhabdomyolysis with simvastatin and nefazodone. Am J Psychiatry 2002; 159: 1607 (letter).