[Drug interaction caused by communication problems. Rhabdomyolysis due to a combination of itraconazole and simvastatin].
A 58-year-old man, who spoke very little Dutch, had various symptoms and used several drugs including simvastatin. He was prescribed itraconazole for onychomycosis. Simvastatin was concurrently replaced with pravastatin to prevent drug interactions. However, the interaction still occurred when the pravastatin ran out, and the patient resumed taking simvastatin on his own initiative. Myalgia and muscle weakness developed after one week. The general practitioner found a strongly elevated creatine kinase level in the blood. The patient required hospitalisation for severe rhabdomyolysis. He was treated with an infusion of an ample quantity of physiological saline solution and made a full recovery. Due to the elevated risk of toxic interactions, doctors should beware of communication problems in complex patients and avoid new prescriptions not strictly required.
Tiessen
Renger G
RG
Afd. Interne Geneeskunde, Universitair Medisch Centrum Groningen, Groningen, The Netherlands. rtiessen@home.nl
Lagerwey
Hendrik Jan G
HJ
Jager
Gea J
GJ
Sprenger
Herman G
HG
D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017964:Itraconazole / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000628:therapy; D019821:Simvastatin / Q000009:adverse effects* / Q000627:therapeutic use
D000935:Antifungal Agents; D000960:Hypolipidemic Agents; D017964:Itraconazole; D019821:Simvastatin