[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

Introduction: 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.

Patients and 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.

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.