title: Rhabdomyolysis caused by Commiphora mukul, a natural lipid-lowering agent.
abstract: OBJECTIVE
  To report a case of rhabdomyolysis caused by Commiphora mukul, a natural lipid-lowering agent.
  
  
  METHODS
  A 55-year-old man was taking an extract of C. mukul 300 mg 3 times daily to lower his cholesterol level. He developed rhabdomyolysis with hemoglobinuria after 2 weeks of treatment. Laboratory tests showed creatine kinase 144600 IU/L (reference range 24-195), myoglobin >3000 ng/mL (28-72), lactate dehydrogenase 7157 IU/L (230-460), aspartate aminotransferase 1115 IU/L (10-35), and alanine aminotransferase 205 IU/L (10-35). Analysis of a urine sample was 2+ positive for hemoglobin. All parameters returned to normal after the herbal preparation was discontinued.
  
  
  CONCLUSIONS
  The Naranjo probability scale indicates C. mukul as the possible cause of rhabdomyolysis in our patient. Drug-induced rhabdomyolysis is an established but rare adverse effect of high doses of cholesterol-lowering agents (statins) or interactions between drugs (eg, statins and fibrates). As of May 28, 2004, to our knowledge, this is the first reported case of rhabdomyolysis following C. mukul ingestion.
  
  
  CONCLUSIONS
  Our report describes a case of rhabdomyolysis possibly caused by C. mukul and underlines the need for active surveillance of natural products.
authors.affiliation: Traditional Medicine Department, Centro di Orientamento Educativo, Barzio, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bianchi
authors.forename: Paola
authors.initials: P
authors.lastname: Cantù
authors.forename: Fabio
authors.initials: F
authors.lastname: Firenzuoli
authors.forename: Gabriela
authors.initials: G
authors.lastname: Mazzanti
authors.forename: Francesca
authors.initials: F
authors.lastname: Menniti-Ippolito
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
mesh_terms: D029744:Commiphora; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy; D010936:Plant Extracts / Q000009:adverse effects; D012206:Rhabdomyolysis / Q000139:chemically induced*
chemical_list: D000960:Hypolipidemic Agents; D010936:Plant Extracts