Abstract
Myopathy, including rhabdomyolysis, is a well-known, albeit rare complication of statin therapy. Predisposing factors include comorbidities and the concomitant use of cytochrome P-450 (CYP) 3A4 inhibitors. We report a case of severe simvastatin-induced rhabdomyolysis triggered by the addition of amiodarone to previously well-tolerated chronic statin therapy. Physicians should be aware of the risk of this potentially severe drug interaction. The dose of simvastatin should be reduced (to 20 mg daily) when concomitant treatment with amiodarone is required, or preference should be given to pravastatin, rosuvastatin or fluvastatin, which are not metabolised by the CYP 3A4.
MeSH terms
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Aged, 80 and over
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Amiodarone* / administration & dosage
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Amiodarone* / adverse effects
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Anti-Arrhythmia Agents / administration & dosage
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Anti-Arrhythmia Agents / adverse effects
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Atrial Fibrillation / complications
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Atrial Fibrillation / drug therapy*
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Atrial Fibrillation / physiopathology
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Comorbidity
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Creatine Kinase / blood
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Cytochrome P-450 CYP3A / metabolism*
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Dose-Response Relationship, Drug
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Drug Interactions
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Humans
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Hypercholesterolemia / complications
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Hypercholesterolemia / drug therapy*
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Hypercholesterolemia / metabolism
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Hypolipidemic Agents / administration & dosage
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Hypolipidemic Agents / adverse effects
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Inactivation, Metabolic
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Male
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Rhabdomyolysis* / etiology
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Rhabdomyolysis* / metabolism
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Rhabdomyolysis* / therapy
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Severity of Illness Index
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Simvastatin* / administration & dosage
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Simvastatin* / adverse effects
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Treatment Outcome
Substances
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Anti-Arrhythmia Agents
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Hypolipidemic Agents
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Simvastatin
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Cytochrome P-450 CYP3A
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Creatine Kinase
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Amiodarone