Rhabdomyolysis induced by concomitant use of atorvastatin calcium and clarithromycin
10.3760/cma.j.cn114015-20220314-00203
- VernacularTitle:阿托伐他汀钙与克拉霉素并用致横纹肌溶解
- Author:
Meizhi LU
1
;
Wenhao LI
;
Shen YANG
;
Wensheng YAN
;
Yunfang ZHANG
Author Information
1. 南方医科大学附属花都医院（广州市花都区人民医院）肾病学科，广州 510000
- Publication Type:Journal Article
- Keywords:
Atorvastatin;
Clarithromycin;
Rhabdomyolysis;
Drug interactions
- From:
Adverse Drug Reactions Journal
2022;24(11):606-608
- CountryChina
- Language:Chinese
-
Abstract:
A 62-year-old male patient received aspirin, clopidogrel, and atorvastatin calcium after percutaneous coronary intervention for coronary atherosclerotic heart disease. One week later, the patient received anti- Helicobacter pylori (Hp) therapy with amoxicillin capsules, clarithromycin tablets, bismuth tartrate capsules, and pantoprazole sodium enteric coated tablets due to Hp infection, and two to three days after taking the drugs, the patient developed systemic fatigue, nausea, joint discomfort and muscle soreness, which were gradually aggravated. Laboratory tests showed muscle hemoglobin (MYO)>1 000 μg/L, serum creatinine (Scr) 69 mmol/L, urea nitrogen (BUN) 3.5 mmol/L, alkaline phosphatase (ALP) 148 U/L, alanine aminotransferase (ALT) 750 U/L, aspartate aminotransferase (AST) 850 U/L, g-glutamyl transpeptidase (γ-GT) 181 U/L, lactate dehydrogenase (LDH) 1 177 U/L, creatine kinase (CK) 8 144 U/L, CK-MB 255 U/L. Atorvastatin calcium was stopped, and symptomatic and supportive treatments such as alkalized urine and fluid replacement were given, and anti-Hp treatments were continued. However, the CK level was continued to increase. CK reached 15 794 U/L 4 days after atorvastatin calcium discontinuation. It was considered that the patient′s rhabdomyolysis might be related to interaction between atorvastatin calcium and clarithromycin. Then the anti-Hp drugs were discontinued. On the 2nd of drug withdrawal, the patients′ muscle soreness was alleviated than before; on the 4th day, CK and other serum enzymology indexes began to decline; on the 8th day, the patient′s fatigue and muscle soreness completely disappeared, with CK 908 U/L; on the 15th day, ALT was 105 U/L, AST was 42 U/L, γ-GT was 107 U/L, CK was 143 U/L, CK-MB was 29 U/L, and LDH was 339 U/L; 5 weeks later, the patient took atorvastatin again, myalgia and fatigue did not recur, and no abnormality was found in blood biochemical indexes.
