title: Weakness and pain in arms and legs · dark urine · history of vertebral osteomyelitis · Dx?
abstract: Rhabdomyolysis is a serious complication of statin treatment. Both higher statin doses and pharmacokinetic factors can raise statin levels, leading to this serious usclerelated syndrome. Co-administration of statins with drugs that are strong inhibitors of cytochrome P450 (CYP) 3A4 (the main cytochrome P450 isoform that metabolizes most statins) can increase statin levels several fold. The trigger for our patient's statin-induced rhabdomyolysis was fluconazole, a known moderate inhibitor of CYP3A4, which is comparatively weaker than certain potent azoles like itraconazole or ketoconazole.
authors.affiliation: Yale-New Haven Hospital, Department of Internal Medicine, CT, USA. Email: antonios.charokopos@yale.edu.
authors.forename: Antonios
authors.initials: A
authors.lastname: Charokopos
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Ohio, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Muhammad
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Ohio, USA.
authors.forename: Sidana
authors.initials: S
authors.lastname: Surbhi
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Ohio, USA.
authors.forename: Andrei
authors.initials: A
authors.lastname: Brateanu
mesh_terms: D000328:Adult; D001132:Arm; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis*; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D007866:Leg; D008297:Male; D054539:Medication Therapy Management; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D063806:Myalgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D065692:Cytochrome P-450 CYP3A Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D015725:Fluconazole