title: Rhabdomyolysis induced by simvastatin-fluconazole combination.
abstract: Rhabdomyolysis is a potential adverse consequence of statin therapy. Here, we report a patient with prostate cancer being treated with simvastatin who developed rhabdomyolysis after coadministration with fluconazole. The rhabdomyolysis promptly resolved after discontinuation of fluconazole, suggesting the possible role of drug interaction in the development of rhabdomyolysis with coadministration of the two medications. Both simvastatin and fluconazole were promptly discontinued, and the patient was admitted to the intensive care unit, where vigorous hydration along with urine alkalinization led to resolution of rhabdomyolysis. Since statins are commonly prescribed treatments for individuals with hyperlipidemia, caution is advised in coadministration with azoles such as fluconazole. Although supportive treatment remains the mainstay of therapy for patients with rhabdomyolysis, fatal consequences can arise from hyperkalemia, cardiac arrhythmia, renal failure and disseminated intravascular coagulation.
authors.affiliation: Faculty of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA. hazin@fas.harvard.edu
authors.forename: Ribhi
authors.initials: R
authors.lastname: Hazin
authors.forename: Jamil Y
authors.initials: JY
authors.lastname: Abuzetun
authors.forename: Manar
authors.initials: M
authors.lastname: Suker
authors.forename: Joann
authors.initials: J
authors.lastname: Porter
mesh_terms: D058186:Acute Kidney Injury; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers; D003402:Creatine Kinase / Q000097:blood; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009212:Myoglobinuria; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D019821:Simvastatin / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D000960:Hypolipidemic Agents; D015725:Fluconazole; D019821:Simvastatin; D003402:Creatine Kinase