Why does atorvastatin cause rhabdomyolysis

Regular medication included simvastatin 80 mg daily. A presumptive diagnosis of rhabdomyolysis secondary to simvastatin was made and both medications were ceased. This was complicated by hyperkalaemia 7. Calcium gluconate was administered for cardio-stabilization due to the significantly elevated potassium despite no acute changes on ECG. Renal replacement therapy was considered, however, avoided as the patient ultimately responded to medical treatment.

The patient reported significant improvement in shoulder and lower limb myalgia and weakness following physiotherapy and was discharged home after returning to his baseline level of function. Following discharge the patient was commenced on long-term prophylactic doxycycline by his respiratory physician and ezetimibe as an alternative to statin therapy. These agents reduce the metabolism and consequently increase the serum concentration of CYP3A4-metabolized statins [ 3 ].

Rhabdomyolysis is characterized by the breakdown of skeletal muscle, resulting in the release of sarcoplasmic proteins including AST, ALT and CK and electrolytes. It typically presents with myalgia and muscle weakness of the proximal musculature.

Patients may report dark urine as a result of myoglobinuria. Potentially life-threatening complications include AKI, hyperkalaemia, compartment syndrome and cardiac arrhythmias. Early rehydration and electrolyte correction is essential in preventing complications, as well as addressing the precipitating cause.

One study conducted by the U. In this case the patient was prescribed 80mg of simvastatin daily; a higher dose associated with an increased risk of statin myopathy. The U. FDA does not recommend initiating new patients on a simvastatin dose of 80 mg, to minimize the risk of statin-induced-myopathy and rhabdomyolysis [ 6 ].

Patients with additional risk factors e. Statin treatment should be discontinued immediately if an elevated CK level is found i. The risk of myopathy or rhabdomyolysis with simvastatin alone is dose related; the incidence, determined from clinical trials, is approximately 0. This risk is increased with concomitant fibrates, as they alone can cause myopathy. Both had significant co-morbidity. To minimise the likelihood of interactions, lower starting doses of simvastatin and atorvastatin should be used in patients already on fibrates, cyclosporin, amiodarone, verapamil, and other potent CYP 3A4 inhibitors.

Sathasivam S, Lecky B. Statin induced myopathy. BMJ ; Rhabdomyolysis updated. Hippokratia ; The broad spectrum of statin myopathy: From myalgia to rhabdomyolysis. Curr Opin Lipidol ; Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs.

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