title: Increased dosage of cyclosporine induces myopathy with increased seru creatine kinase in an elderly patient on chronic statin therapy.
abstract: OBJECTIVE
  The concomitant administration of atorvastatin and cyclosporine has been shown to increase the serum concentration of 3-hydroxy-3-methylglutaryl coenzyme A, which may be associated with the elevation of creatine kinase and an increased risk of myopathy. Our objective is to report on a case of statin-induced myopathy associated with concomitant use of cyclosporine and other contributing factors.
  
  
  METHODS
  An 88-year-old Chinese male patient with comorbidities received polypharmacy treatment, including atorvastatin and cyclosporine. After the dosage of cyclosporine was increased to 300 mg every day for 8 months, the patient developed body pain and leg weakness, with a serum creatine kinase increase and evidence on magnetic resonance imaging of muscle oedema.
  
  
  CONCLUSIONS
  Cyclosporine is a moderate inhibitor of the cytochrome P450 CYP3A4 isoenzyme, which is known to increase the serum level of atorvastatin. We hypothesized that the pharmacological and pharmacokinetic properties of atorvastatin-induced myopathy are the result of its interaction with high dosage of cyclosporine.
authors.affiliation: The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: L
authors.initials: L
authors.lastname: Mo
authors.forename: J
authors.initials: J
authors.lastname: He
authors.forename: Q
authors.initials: Q
authors.lastname: Yue
authors.forename: B
authors.initials: B
authors.lastname: Dong
authors.forename: X
authors.initials: X
authors.lastname: Huang
mesh_terms: D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D000069059:Atorvastatin / Q000009:adverse effects* / Q000493:pharmacokinetics; D002681:China; D016572:Cyclosporine / Q000494:pharmacology*; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004794:Enzyme Repression; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced*; D009211:Myoglobin / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D009211:Myoglobin; D016572:Cyclosporine; D000069059:Atorvastatin; D051544:Cytochrome P-450 CYP3A; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: creatine kinase; cyclosporine; drug-drug interactions; myopathy; statin