title: Rapid onset of muscle weakness (rhabdomyolysis) associated with the combined use of simvastatin and colchicine.
abstract: We report a case of a patient with mild chronic renal insufficiency who had been taking simvastatin for over a year and developed acute weakness within 3 weeks after the start of treatment with colchicine for acute gouty bursitis. Profound muscle weakness of lower extremities with inability to stand up and/or walk was present. Elevated muscle enzymes and findings on electromyography were consistent with myopathy. Rapid improvement in muscle strength accompanied by prompt resolution of abnormal elevation of muscle enzymes followed cessation of both medications. Both colchicine and statin therapy may be associated with myopathy, which usually occurs after several months of therapy. The concomitant use, however, of colchicine and statin has been associated with the rapid onset of muscle weakness. Four patients with similar clinical and laboratory characteristics to our patient's after the combined use of colchicine and statins have been described in the literature. Patients receiving combination therapy with colchicine and simvastatin, particularly in the presence of renal insufficiency, should be monitored for the development of myopathy, including rhabdomyolysis.
authors.affiliation: Rheumatology Section, Department of Internal Medicine, LSU Health Sciences Center, 2020 Gravier Street, New Orleans, LA 70112, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Justiniano
authors.forename: Sylvia
authors.initials: S
authors.lastname: Dold
authors.forename: Luis R
authors.initials: LR
authors.lastname: Espinoza
mesh_terms: D015210:Arthritis, Gouty / Q000188:drug therapy; D002062:Bursitis / Q000188:drug therapy; D003078:Colchicine / Q000009:adverse effects*; D004357:Drug Synergism; D005260:Female; D006074:Gout Suppressants / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012206:Rhabdomyolysis / Q000139:chemically induced*; D019821:Simvastatin / Q000009:adverse effects*
chemical_list: D006074:Gout Suppressants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D003078:Colchicine