title: Muscular damage during telbivudine treatment in a chronic hepatitis B patient.
abstract: Muscle tissue damage might be related to metabolic and mechanical factors. Certain drugs have been associated with increased blood levels of creatin phospho kinase (CPK) and myoglobin that are biochemical markers of musculoskeletal damage. An increase of CPK plasma levels might suggest severe rhabdomyolysis with possible resulting renal failure. Telbivudine is an antiviral drug indicated for the treatment of chronic hepatitis B (CHB) in adult patients. An increase in CPK plasma levels has been recently described in some telbivudine-treated CHB patients without muscle-skeletal symptoms. In this paper we report a CHB patient that developed a severe increase of CPK plasma levels during telbivudine-treatment. Pharmacological evaluation, using the Naranjo probability scale, indicated a probable relationship between telbivudine and CPK increase, so telbivudine was discontinued and replaced with entecavir with a complete resolution of laboratory findings. In conclusion, telbivudine treatment can induce muscular damage in the absence of skeletal injury, therefore we suggest to closely monitor the muscular function of the patients treated with this drug in order to prevent possible major complications.
authors.affiliation: Department of Health Science School of Medicine, University "Magna Graecia" of Catanzaro, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Caroleo
authors.forename: Olimpio
authors.initials: O
authors.lastname: Galasso
authors.forename: Orietta
authors.initials: O
authors.lastname: Staltari
authors.forename: Chiara
authors.initials: C
authors.lastname: Giofrè
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guadagnino
authors.forename: Luca
authors.initials: L
authors.lastname: Gallelli
keywords: CPK; chronic hepatitis B; muscular damage; telbivudine