J Korean Med Sci.  2011 Dec;26(12):1634-1637. 10.3346/jkms.2011.26.12.1634.

Fatal Rhabdomyolysis in a Patient with Liver Cirrhosis after Switching from Simvastatin to Fluvastatin

Affiliations
  • 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Inje University College of Medicine, Busan, Korea. thkim@paik.ac.kr

Abstract

HMG-CoA reductase inhibitors (statins) are widely used to treat hypercholesterolemia. Among the adverse effects associated with these drugs are statin-associated myopathies, ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis. Fluvastatin-induced fatal rhabdomyolysis has not been previously reported. We describe here a patient with liver cirrhosis who experienced fluvastatin-induced fatal rhabdomyolysis. This patient had been treated with simvastatin (20 mg/day) for coronary artery disease and was switched to fluvastatin (20 mg/day) 10 days before admission. He was also taking aspirin, betaxolol, candesartan, lactulose, and entecavir. Rhabdomyolysis was complicated and continued to progress. He was treated with massive hydration, urine alkalization, intravenous furosemide, and continuous renal replacement therapy for acute renal failure, but eventually died due to rhabdomyolysis complicated by hepatic failure. In conclusion, fluvastatin should be used with caution in patients with liver cirrhosis, especially with other medications metabolized with CYP2C9.

Keyword

Rhabdomyolysis; Liver Cirrhosis; Simvastatin; Fluvastatin

MeSH Terms

Coronary Artery Disease/complications/*drug therapy
Fatal Outcome
Fatty Acids, Monounsaturated/administration & dosage/*adverse effects/therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage/*adverse effects/therapeutic use
Indoles/administration & dosage/*adverse effects/therapeutic use
Liver Cirrhosis/*complications
Male
Middle Aged
Rhabdomyolysis/*chemically induced
Simvastatin/administration & dosage/therapeutic use

Figure

  • Fig. 1 A 99mTc-diphosphonate scintigram bone scan showed increased uptake over all extremities and muscles of the thorax and abdomen.

  • Fig. 2 Changes in serum CK and PT concentrations during admission. CRRT, continous renal replacement therapy.


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