title: [Rhabdomyolysis associated with atorvastatin combined with amiodarone and fluconazole].
abstract: A 67-year old man was hospitalized due to an aorto-coronary bypass and cecal perforation. After administration of atorvastatin, amiodarone, and fluconazole, rhabdomyolysis developed with electrolyte disturbances (hyperphosphatemia, hyopcalcemia) and a massive increase in creatine kinase and myoglobin. In the clinical course, other complications manifested such as acute renal failure, critical illness myopathy, acute gout on the knee, and sternal infection with coagulase-negative staphylococci. After stopping the assumed causal agents and treating the complications, the patient could be transferred for rehabilitation after a more than two months hospital stay. We discuss the causes and symptoms of muscle diseases as well as the epidemiology, mechanisms, treatment, and prevention of drug-induced myopathies with a focus on statins.
authors.affiliation: Abteilung für Klinische Pharmakologie und Toxikologie und Regionales Pharmakovigilance Zentrum Basel, Universitätsspital Basel. Franzc@uhbs.ch
authors.forename: C C
authors.initials: CC
authors.lastname: Franz
authors.forename: M
authors.initials: M
authors.lastname: Bruggisser
authors.forename: S
authors.initials: S
authors.lastname: Krähenbühl
authors.forename: A E
authors.initials: AE
authors.lastname: Rätz Bravo
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000069059:Atorvastatin; D047549:Coronary Artery Bypass, Off-Pump; D051544:Cytochrome P-450 CYP3A; D065692:Cytochrome P-450 CYP3A Inhibitors; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D012206:Rhabdomyolysis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000889:Anti-Arrhythmia Agents; D000924:Anticholesteremic Agents; D000935:Antifungal Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D006538:Heptanoic Acids; D011758:Pyrroles; D015725:Fluconazole; D000069059:Atorvastatin; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D000638:Amiodarone