Fenoverine-induced Rhabdomyolysis in a Patient with Liver Cirrhosis

Park, So Young; Lee, Kyung Ju; Song, Joon Ho; Lee, Seoung Woo; Kim, Moon Jae

Abstract

Fenoverine is a drug with a phenothiazine structure which has a non-atropine-like spasmolytic action on the smooth muscle by inhibiting calcium channel currents. Recently, it has been occasionally reported that fenoverine can cause rhabdomyolysis under the certain conditions such as hepatic dysfunction, concomitant use of HMG-CoA reductase, mitochondrial myopathy, lipid storage myopathy or malingnat hyperthermia. We describe here a patient with fenoverine-induced rhabdomyolysis and ARF. An 38 year-old male liver cirrhosis patient, who had been received fenoverine 300mg daily for a month, admitted with generalache, weakness and oliguria. The patient showed typical laboratory findings of rhabdomyolysis and bone scan showed extensive uptake of Tc-99m MDP in muscle. No other traumatic, metabolic, toxic or enzymatic causes of the rhabdomyolysis were found in careful history. The patient recovered from rhabdomyolysis after drug discontinuation and dialysis treatment for ARF. Pre-existing hepatic dysfunction might had induced the accumulation of fenoverine and subsequent rhabdomyolysis in this patient. The incidence of muscular complications of fenoverine therapy could be reduced by avoidance of prescription of this drug in patients with hepatopathy or those being treated with cholesterol-lowing agents. Physicians shold be aware of life-threatening adverse effects of apparently innocuous drugs.