title: [Rhabdomyolysis and severe hepatotoxicity due to a drug-drug interaction between ritonavir and simvastatin. Could we use the most cost-effective statin in all human immunodeficiency virus-infected patients?].
abstract: BACKGROUND
  Drugs like statins may induce rhabdomyolysis. Simvastatin and lovastatin have a high hepatic metabolism and their potential toxicity could be increased by interactions with other drugs that reduce their metabolism.
  
  
  METHODS
  A case-report is presented of an HIV-infected patient treated with antiretroviral drugs who developed a rhabdomyolysis-induced renal failure and liver toxicity when simvastatin was substituted for atorvastatin. A literature review is also presented.
  
  
  RESULTS
  The patient required hospital admission and showed a favorable response after hydration and urine alkalinization. There were 4 additional cases published of which there was one death.
  
  
  CONCLUSIONS
  Drug-drug interactions can increase the risk of statin induced rhabdomyolysis. In order to evaluate them properly, physicians at all levels of clinical care should be aware of all drugs prescribed to their patients and the contraindicated combinations.
authors.affiliation: Servicio de Farmacia, Hospital Clínic, Barcelona, España. Electronic address: cbastida@clinic.ub.es.
authors.forename: Carla
authors.initials: C
authors.lastname: Bastida
authors.affiliation: Servicio de Enfermedades Infecciosas, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Also
authors.affiliation: Servicio de Enfermedades Infecciosas, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Pericas
authors.affiliation: Swiss Tropical and Public Health Institute (Swiss TPH), Basilea, Suiza; Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, España.
authors.forename: Emili
authors.initials: E
authors.lastname: Letang
authors.affiliation: Servicio de Farmacia, Hospital Clínic, Barcelona, España.
authors.forename: Montse
authors.initials: M
authors.lastname: Tuset
authors.affiliation: Servicio de Enfermedades Infecciosas, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Miró
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D000069059:Atorvastatin / Q000191:economics / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000517:prevention & control; D015897:Comorbidity; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D057915:Drug Substitution / Q000009:adverse effects; D004357:Drug Synergism; D050171:Dyslipidemias / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000517:prevention & control; D019438:Ritonavir / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D019821:Simvastatin / Q000009:adverse effects* / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D065692:Cytochrome P-450 CYP3A Inhibitors; D017320:HIV Protease Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069059:Atorvastatin; D019821:Simvastatin; D019438:Ritonavir
keywords: Antiretroviral drugs; Drug-drug interactions; Estatinas; Hepatotoxicidad; Hepatotoxicity; Human immunodeficiency virus; Hydroxymethylglutaryl-CoA reductase inhibitors; Inhibidores de la hidroximetilglutaril-coA reductasa; Insuficiencia renal; Interacciones medicamentosas; Rabdomiólisis; Renal failure; Rhabdomyolysis; Ritonavir; Simvastatin; Simvastatina; Statins; Tratamiento antirretroviral; Virus de la inmunodeficiencia humana