Itraconazole-induced rhabdomyolysis and acute renal failure in a heart transplant recipient treated with simvastatin and cyclosporine.
BACKGROUND
Statins are widely used to decrease cholesterol and improve morbidity and mortality associated with coronary artery disease. Myopathy constitutes a rare but potentially life-threatening adverse reaction, which is related to plasma HMG-CoA reductase inhibitory activity. Therefore, the incidence of rhabdomyolysis increases dramatically when statins are co-administered with drugs that inhibit their hepatic transformation, such as cyclosporine or azoles.


RESULTS
We present a case of severe rhabdomyolysis and acute renal failure induced by itraconazole in a heart transplant recipient chronically treated with cyclosporine and simvastatin. The literature with regard to the pathogenetic mechanisms and the clinical implications are reviewed.


CONCLUSIONS
To avoid severe myopathy, cyclosporine levels should be monitored sooner than weekly intervals and statins should be discontinued or their dosage should be reduced, as long as azoles need to be prescribed in transplant recipients. Rhabdomyolysis and acute renal insufficiency should be promptly recognized and aggressively treated.
Aretaieion University Hospital and Onassis Cardiac Surgery Center, Athens, Greece. vlahakos@otenet.gr
D V
DV
Vlahakos
A
A
Manginas
D
D
Chilidou
C
C
Zamanika
P A
PA
Alivizatos
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000935:Antifungal Agents / Q000009:adverse effects*; D016572:Cyclosporine / Q000009:adverse effects*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D017964:Itraconazole / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000139:chemically induced*; D019821:Simvastatin / Q000009:adverse effects*
D000935:Antifungal Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D017964:Itraconazole; D016572:Cyclosporine; D019821:Simvastatin