title: Rhabdomyolysis after midazolam administration in a cirrhotic patient treated with atorvastatin.
abstract: The administration of statins in patients with liver disease is not an absolute contraindication. Hepatotoxicity is a rare and often dose-related event and in the literature there are only a few described cases of fatal rhabdomyolysis in patients with chronic liver disease after statin administration. During treatment with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, the factors responsible for myopathy may either be related to the patient, or due to interactions with other medications that are metabolic substrates of the same isozymes and therefore able to increase blood statin concentration. The most important side effects consist of increased transaminase levels, abdominal pain or muscle weakness, increased serum levels of creatine kinase and rhabdomyolysis. In this article we report a case of fatal rhabdomyolysis with acute renal failure after gastric endoscopy, where midazolam was used as a sedation agent in a patient with chronic liver disease treated with a high dose of atorvastatin. Therefore, we suggest paying particular attention to the potential risks of associating atorvastatin and midazolam in patients with chronic liver disease who need to undergo gastric endoscopy.
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Gigante
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Gianluca Di Lazzaro
authors.initials: GD
authors.lastname: Giraldi
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Maria Ludovica
authors.initials: ML
authors.lastname: Gasperini
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Barbano
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Liberatori
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Liborio
authors.initials: L
authors.lastname: Sardo
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Francesca Di
authors.initials: FD
authors.lastname: Mario
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Giorgi
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rossi-Fanelli
authors.affiliation: Antonietta Gigante, Gianluca Di Lazzaro Giraldi, Maria Ludovica Gasperini, Biagio Barbano, Marta Liberatori, Liborio Sardo, Francesca Di Mario, Antonella Giorgi, Filippo Rossi-Fanelli, Antonio Amoroso, Department of Clinical Medicine, "Sapienza" University of Rome, 00185 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
keywords: Alcoholic liver cirrhosis; Chronic liver disease; Midazolam; Rhabdomyolysis; Statins