title: Concomitant use of simvastatin and amiodarone resulting in severe rhabdomyolysis: a case report and review of the literature.
abstract: Myopathy, including rhabdomyolysis, is a well-known, albeit rare complication of statin therapy. Predisposing factors include comorbidities and the concomitant use of cytochrome P-450 (CYP) 3A4 inhibitors. We report a case of severe simvastatin-induced rhabdomyolysis triggered by the addition of amiodarone to previously well-tolerated chronic statin therapy. Physicians should be aware of the risk of this potentially severe drug interaction. The dose of simvastatin should be reduced (to 20 mg daily) when concomitant treatment with amiodarone is required, or preference should be given to pravastatin, rosuvastatin or fluvastatin, which are not metabolised by the CYP 3A4.
authors.affiliation: Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Marot
authors.forename: J
authors.initials: J
authors.lastname: Morelle
authors.forename: V A
authors.initials: VA
authors.lastname: Chouinard
authors.forename: M
authors.initials: M
authors.lastname: Jadoul
authors.forename: M
authors.initials: M
authors.lastname: Lambert
authors.forename: N
authors.initials: N
authors.lastname: Demoulin
mesh_terms: D000369:Aged, 80 and over; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015897:Comorbidity; D003402:Creatine Kinase / Q000097:blood; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008658:Inactivation, Metabolic; D008297:Male; D012206:Rhabdomyolysis / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D012720:Severity of Illness Index; D019821:Simvastatin / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000960:Hypolipidemic Agents; D019821:Simvastatin; D051544:Cytochrome P-450 CYP3A; D003402:Creatine Kinase; D000638:Amiodarone