title: Rhabdomyolysis a result of azithromycin and statins: an unrecognized interaction.
abstract: OBJECTIVE
  In a systematic screening of the World Health Organization Adverse Drug Reaction database, VigiBase, in July 2008, a measure of association used to detect interactions (Omega) highlighted azithromycin with the individual statins atorvastatin, lovastatin and simvastatin and rhabdomyolysis. The aim was to examine all reports including rhabdomyolysis-azithromycin and statins in VigiBase to assess if the data were suggestive of an interaction.
  
  
  METHODS
  The individual case reports in VigiBase and the original files were reviewed. In order to investigate the reporting over time for rhabdomyolysis with azithromycin and statins to VigiBase, Omega values were generated retrospectively.
  
  
  RESULTS
  The reporting over time showed that rhabdomyolysis under concomitant use of azithromycin and statins was reported more often than expected from 2000 and onwards in Vigibase. After exclusion of possible duplicates and follow-up reports, 53 cases from five countries remained. Rhabdomyolysis occurred shortly after initiation of azithromycin in 23% of cases. In 11 patients an interaction had been suggested by the reporter. With the exception of one patient, the statin doses reported were within the recommended daily doses.
  
  
  CONCLUSIONS
  Case reports in VigiBase are suggestive that interactions between azithromycin and statins resulting in rhabdomyolysis may occur. This analysis showed the potential of the newly developed disproportionality measure, Omega, which can help to identify drug interactions in VigiBase in the future. The results also showed that reviewing spontaneous reports can add information to drug interactions not established previously.
authors.affiliation: The Uppsala Monitoring Centre, WHO Collaborating Centre for International Drug Monitoring, Uppsala, Sweden. johanna.strandell@who-umc.org
authors.forename: Johanna
authors.initials: J
authors.lastname: Strandell
authors.forename: Andrew
authors.initials: A
authors.lastname: Bate
authors.forename: Staffan
authors.initials: S
authors.lastname: Hägg
authors.forename: I Ralph
authors.initials: IR
authors.lastname: Edwards
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000069059:Atorvastatin; D017963:Azithromycin; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006538:Heptanoic Acids; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008148:Lovastatin; D008297:Male; D008875:Middle Aged; D017035:Pravastatin; D011725:Pyridines; D011758:Pyrroles; D012206:Rhabdomyolysis / Q000139:chemically induced*; D019821:Simvastatin
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011725:Pyridines; D011758:Pyrroles; D017963:Azithromycin; D008148:Lovastatin; D000069059:Atorvastatin; D019821:Simvastatin; C086276:cerivastatin; D017035:Pravastatin