J Lipid Atheroscler.  2024 Jan;13(1):61-68. 10.12997/jla.2024.13.1.61.

Statins Ticagrelor and Rhabdomyolysis: A Coincidence or a Drug Interaction?

• Patel R
• Sharma JB
• Rajput S

• KMID: 2552250
• DOI: http://doi.org/10.12997/jla.2024.13.1.61

Abstract

Objective
Statins play a key role in the management of atherosclerotic cardiovascular disease for both primary and secondary prevention. However, their increasing usage has correspondingly led to a higher incidence of adverse effects, with muscle symptoms being the most common. An intriguing drug interaction exists between ticagrelor and high-intensity statins, which may exacerbate the adverse effects of statin-induced rhabdomyolysis, leading to significant consequences. This study was conducted to examine the profile of patients who have experienced statin-induced rhabdomyolysis while undergoing percutaneous transluminal coronary angioplasty (PTCA).
Methods
This was an observational study that included 1,862 patients who underwent PTCA at our institute over the course of 1 year.
Results
Over a 1-year period, we encountered four patients who were being treated with high-intensity statin therapy following acute coronary syndrome. These patients presented with muscle weakness and kidney injury. A notable commonality among all patients was the co-prescription of ticagrelor. Two patients died, while the other 2 were successfully managed through hydration, electrolyte balance, dialysis, and alternative lipid management drugs.
Conclusion
The concomitant use of ticagrelor and high-intensity statins should be carefully considered due to the additional risk of rhabdomyolysis and kidney injury. Future pharmacokinetic studies are needed to establish a causal relationship and predict potential drug interactions, which, if not avoided, could be fatal.

Keyword

Statins; Rhabdomyolysis; Drug interactions; Adverse drug reactions; Ticagrelor