Levofloxacin-induced rhabdomyolysis in a patient on concurrent atorvastatin: Case report and literature review

J Clin Pharm Ther. 2019 Dec;44(6):966-969. doi: 10.1111/jcpt.13010. Epub 2019 Aug 13.

Abstract

What is known and objective: The combination of HMG-CoA reductase inhibitors (statins) and fluoroquinolones generally is not considered a significant risk factor for rhabdomyolysis. Rhabdomyolysis is a known risk associated with statin therapy but has seldom been described with fluoroquinolone use. We describe a case of acute rhabdomyolysis involving the co-administration of atorvastatin and levofloxacin.

Case description: A 65-year-old white male presented with clinical and laboratory evidence of rhabdomyolysis after approximately 19 days of levofloxacin therapy for treatment of a prosthetic joint infection. His symptoms resolved after discontinuation of levofloxacin and atorvastatin therapy and did not recur following reintroduction of atorvastatin therapy.

What is new and conclusion: Delayed-onset rhabdomyolysis may occur in patients receiving levofloxacin. Weekly complete metabolic panels along with patient education about symptoms of rhabdomyolysis should be considered, particularly in patients on concurrent medications known to cause rhabdomyolysis.

Keywords: atorvastatin; fluoroquinolones; levofloxacin; rhabdomyolysis; statins.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Infective Agents, Urinary / adverse effects*
  • Anticholesteremic Agents / therapeutic use*
  • Atorvastatin / therapeutic use*
  • Humans
  • Levofloxacin / adverse effects*
  • Levofloxacin / therapeutic use
  • Male
  • Rhabdomyolysis / chemically induced*

Substances

  • Anti-Infective Agents, Urinary
  • Anticholesteremic Agents
  • Levofloxacin
  • Atorvastatin