Renal failure and rhabdomyolysis associated with sitagliptin and simvastatin use.
BACKGROUND
Sitagliptin is a new oral glucose-lowering medication that acts via the incretin hormone system. The most common side-effects are headache and pharyngitis, and few serious adverse events were observed during clinical trials. Dose adjustment is recommended in renal insufficiency, but long-term safety experience is limited.


METHODS
We present a patient with chronic renal insufficiency who developed leg pain, weakness and tenderness after starting treatment with high-dose sitagliptin while on simvastatin. The patient had acute renal failure and rhabdomyolysis that resolved with cessation of sitagliptin, simvastatin, ezetimibe, diuretics and olmesartan. All drugs except sitagliptin, ezetimibe and simvastatin were resumed, and the patient was subsequently started on lovastatin without recurrence of rhabdomyolysis.


CONCLUSIONS
High doses of sitagliptin may have worsened this patient's renal failure and precipitated rhabdomyolysis by increasing circulating levels of simvastatin. Given the high likelihood that sitagliptin will be co-administered with statins and renally active medications, further study of long-term safety of sitagliptin in renal sufficiency may be warranted.
Kao
D P
DP
Stanford University School of Medicine, Department of Medicine, Stanford, CA, USA. dkao42@yahoo.com
Kohrt
H E
HE
Kugler
J
J
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D011719:Pyrazines / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced*; D019821:Simvastatin / Q000627:therapeutic use*; D000068900:Sitagliptin Phosphate; D014230:Triazoles / Q000009:adverse effects*
D054873:Dipeptidyl-Peptidase IV Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011719:Pyrazines; D014230:Triazoles; D019821:Simvastatin; D000068900:Sitagliptin Phosphate