title: Fatal rhabdomyolysis in a patient with liver cirrhosis after switching from simvastatin to fluvastatin.
abstract: HMG-CoA reductase inhibitors (statins) are widely used to treat hypercholesterolemia. Among the adverse effects associated with these drugs are statin-associated myopathies, ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis. Fluvastatin-induced fatal rhabdomyolysis has not been previously reported. We describe here a patient with liver cirrhosis who experienced fluvastatin-induced fatal rhabdomyolysis. This patient had been treated with simvastatin (20 mg/day) for coronary artery disease and was switched to fluvastatin (20 mg/day) 10 days before admission. He was also taking aspirin, betaxolol, candesartan, lactulose, and entecavir. Rhabdomyolysis was complicated and continued to progress. He was treated with massive hydration, urine alkalization, intravenous furosemide, and continuous renal replacement therapy for acute renal failure, but eventually died due to rhabdomyolysis complicated by hepatic failure. In conclusion, fluvastatin should be used with caution in patients with liver cirrhosis, especially with other medications metabolized with CYP2C9.
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung Don
authors.initials: SD
authors.lastname: Baek
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Jang
authors.forename: So-Eun
authors.initials: SE
authors.lastname: Park
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Ok
authors.forename: Jaechan
authors.initials: J
authors.lastname: Leem
authors.forename: Ho-Su
authors.initials: HS
authors.lastname: Lee
authors.forename: So Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Kim
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D017809:Fatal Outcome; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000139:chemically induced*; D019821:Simvastatin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin; D019821:Simvastatin