Atorvastatin-induced early-onset rhabdomyolysis in a patient with nephrotic syndrome

J. Jose, K. Saravu, B.A. Shastry

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose. A case of early-onset rhabdomyolysis in a patient treated with atorvastatin is described. Summary. A 17-year-old Indian boy weighing 55 kg was admitted to the hospital after complaining of facial puffiness and pedal edema for four days. His medical history revealed a diagnosis of nephrotic syndrome when he was 2 years old. He had six relapses, the last of which occurred 10 years ago. He was not taking any medications on admission and had not for the past 9 years. His vital signs were normal on admission (day 1), but anasarca was noticed during general examination. Cardiovascular, respiratory, and abdominal examinations were normal. Relapse of nephrotic syndrome was considered, and his 24-hour urine protein value confirmed the diagnosis. Further laboratory tests revealed that the patient had high total and low-density-lipoprotein cholesterol values (597 and 465 mg/dL, respectively), and atorvastatin 10 mg p.o. once daily was initiated on day 2. Prednisolone 60 mg p.o. once daily was initiated on day 3. On day 6, the patient complained of pain in both thighs and had difficulty walking. His creatine kinase (CK) concentration was then measured and found to be elevated (11,821 IU/L). Prednisolone and atorvastatin were then stopped, as statin-induced myopathy was suspected. The patient received i.v. hydration and sodium bicarbonate, and he began to show improvement by day 9. Follow-up three weeks later revealed a normal CK level and no myopathy-related complaints. Conclusion. Early-onset rhabdomyolysis was reported in a patient with nephrotic syndrome who was treated with atorvastatin. Concomitant use of prednisolone and the patient's underlying renal impairment may have predisposed the patient to this adverse reaction. Copyright © 2007, American Society of Health-System Pharmacists, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)726-729
Number of pages4
JournalAmerican Journal of Health-System Pharmacy
Volume64
Issue number7
DOIs
Publication statusPublished - 2007

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Rhabdomyolysis
Nephrotic Syndrome
Prednisolone
Muscular Diseases
Creatine Kinase
Edema
Mobility Limitation
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Recurrence
Sodium Bicarbonate
Vital Signs
Thigh
Atorvastatin Calcium
LDL Cholesterol
Foot
Urine
Kidney
Pain

Cite this

@article{79505dc2548c45d0bd68047fa3b1a1f3,
title = "Atorvastatin-induced early-onset rhabdomyolysis in a patient with nephrotic syndrome",
abstract = "Purpose. A case of early-onset rhabdomyolysis in a patient treated with atorvastatin is described. Summary. A 17-year-old Indian boy weighing 55 kg was admitted to the hospital after complaining of facial puffiness and pedal edema for four days. His medical history revealed a diagnosis of nephrotic syndrome when he was 2 years old. He had six relapses, the last of which occurred 10 years ago. He was not taking any medications on admission and had not for the past 9 years. His vital signs were normal on admission (day 1), but anasarca was noticed during general examination. Cardiovascular, respiratory, and abdominal examinations were normal. Relapse of nephrotic syndrome was considered, and his 24-hour urine protein value confirmed the diagnosis. Further laboratory tests revealed that the patient had high total and low-density-lipoprotein cholesterol values (597 and 465 mg/dL, respectively), and atorvastatin 10 mg p.o. once daily was initiated on day 2. Prednisolone 60 mg p.o. once daily was initiated on day 3. On day 6, the patient complained of pain in both thighs and had difficulty walking. His creatine kinase (CK) concentration was then measured and found to be elevated (11,821 IU/L). Prednisolone and atorvastatin were then stopped, as statin-induced myopathy was suspected. The patient received i.v. hydration and sodium bicarbonate, and he began to show improvement by day 9. Follow-up three weeks later revealed a normal CK level and no myopathy-related complaints. Conclusion. Early-onset rhabdomyolysis was reported in a patient with nephrotic syndrome who was treated with atorvastatin. Concomitant use of prednisolone and the patient's underlying renal impairment may have predisposed the patient to this adverse reaction. Copyright {\circledC} 2007, American Society of Health-System Pharmacists, Inc. All rights reserved.",
author = "J. Jose and K. Saravu and B.A. Shastry",
note = "Cited By :12 Export Date: 10 November 2017 CODEN: AHSPE Correspondence Address: Jose, J.; Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; email: jimmy_jose2001@yahoo.com Chemicals/CAS: atorvastatin, 134523-00-5, 134523-03-8; bicarbonate, 144-55-8, 71-52-3; creatine kinase, 9001-15-4; prednisolone, 50-24-8; atorvastatin, 110862-48-1; Heptanoic Acids; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Pyrroles References: Omar, M.A., Wilson, J.P., Cox, T.S., Rhabdomyolysis and HMG-CoA reductase inhibitors (2001) Ann Pharmacother, 35, pp. 1096-1107; [Erratum, Ann Pharmacother. 2001; 35:1296.]; Jamal, S.M., Eisenberg, M.J., Christopoulos, S., Rhabdomyolysis associated with hydroxymethylglutaryl-coenzyme A reductase inhibitors (2004) Am Heart J, 147, pp. 956-965; Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis. N Engl J Med. 2002; 346:539-40. Letter; Omar, M.A., Wilson, J.P., FDA adverse event reports on statin-associated rhabdomyolysis (2002) Ann Pharmacother, 36, pp. 288-295; Antons, K.A., Williams, C.D., Baker, S.K., Clinical perspectives of statin-induced rhabdomyolysis (2006) Am J Med, 119, pp. 400-409; Corsini, A., Bellosta, S., Baetta, R., New insights into the pharmacodynamic and pharmacokinetic properties of statins (1999) Pharmacol Ther, 84, pp. 413-428; [Erratum, Pharmacol Ther. 2000; 86:199.]; Slater, E.E., MacDonald, J.S., Mechanism of action and biological profile of HMG CoA reductase inhibitors. A new therapeutic alternative (1988) Drugs, 36 (SUPPL. 3), pp. 72-82; Flint, O.P., Masters, B.A., Gregg, R.E., Inhibition of cholesterol synthesis by squalene synthase inhibitors does not induce myotoxicity in vitro (1997) Toxicol Appl Pharmacol, 145, pp. 91-98; Folkers, K., Langsjoen, P., Willis, R., Lovastatin decreases coenzyme Q levels in humans (1990) Proc Natl Acad Sci, 87, pp. 8931-8934; Guijarro, C., Blanco-Colio, L.M., Ortego, M., 3-Hydroxy-3-methylglutaryl coenzyme A reductase and isoprenylation inhibitors induce apoptosis of vascular smooth muscle cells in culture (1998) Circ Res, 83, pp. 490-500; Knapp, A.C., Huang, J., Starling, G., Inhibitors of HMG-CoA-reductase sensitize human smooth muscle cells to Fas-ligand and cytokine-induced cell death (2000) Atherosclerosis, 152, pp. 217-227; Pierno, S., De Luca, A., Tricarico, D., Experimental evaluation of the effects of pravastatin on electrophysiological parameters of rat skeletal muscle (1992) Pharmacol Toxicol, 71, pp. 325-329; Igel, M., Sudhop, T., von Bergmann, K., Metabolism and drug interactions of 3-hydroxy-3-methylglutaryl coenzyme A-reductase inhibitors (statins) (2001) Eur J Clin Pharmacol, 57, pp. 357-364; Thompson, P.D., Clarkson, P., Karas, R.H., Statin-associated myopathy (2003) JAMA, 289, pp. 1681-1690; The HMG Co-A reductase inhibitors ('statins') and myotoxic effects. S Afr Med J. 2002; 92:596-7; Ogg, M.S., Williams, J.M., Tarbit, M., A reporter gene assay to assess the molecular mechanisms of xenobiotic-dependent induction of the human CYP3A4 gene in vitro (1999) Xenobiotica, 29, pp. 269-279; El-Sankary, W., Bombail, V., Gibson, G.G., Glucocorticoid-mediated induction of CYP3A4 is decreased by disruption of a protein: DNA interaction distinct from the pregnane X receptor response element (2002) Drug Metab Dispos, 30, pp. 1029-1034; Jamil, S., Iqbal, P., Rhabdomyolysis induced by a single dose of a statin (2004) Heart, 90, pp. e3; Ardati A, Stolley P, Knapp DE et al. Statin-associated rhabdomyolysis. Pharmacoepidemiol Drug Saf. 2005; 14:287. Letter; Savage, R., Tatley, M., Myopathy with statins: Check CK levels and interactions (2004) Prescr Update, 25 (1), pp. 4-5; Graham, D.J., Staffa, J.A., Shatin, D., Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs (2004) JAMA, 292, pp. 2585-2590; Naranjo, C.A., Busto, U., Sellers, E.M., A method for estimating the probability of adverse drug reactions (1981) Clin Pharmacol Ther, 30, pp. 239-245; Brady, H.R., O'Meara, Y.M., Brenner, B.M., Glomerular diseases (2005) Harrison's principles of internal medicine, pp. 1674-1694. , Kasper DL, Braunwald E, Hauser SL et al, eds, 16th ed. New York: McGraw Hill;; Spitalewitz, S., Ponish, J.G., Cattran, D., Treatment of hyperlipidemia in the nephrotic syndrome: The effects of pravastatin therapy (1993) Am J Kidney Dis, 22, pp. 143-150; Biesenbach, G., Zazgornik, J., Lovastatin in the treatment of hypercholesterolemia in nephrotic syndrome due to diabetic nephropathy stage IV-V (1992) Clin Nephrol, 37, pp. 274-279; Olbricht, C.J., Wanner, C., Thiery, J., Simvastatin in nephrotic syndrome (1999) Kidney Int Suppl, 56, pp. S113-S116; Prescott Jr, W.A., Streetman, D.A., Streetman, D.S., The potential role of HMG-CoA reductase inhibitors in pediatric nephrotic syndrome (2004) Ann Pharmacother, 38, pp. 2105-2114; Deak, G., Ruzicska, E., Somogyi, A., Association of IgA nephropathy, hypothyroidism and hypercholesterolemia (2005) J Nephrol, 18, pp. 773-776; Glomerular diseases. In: Beers MH, Berkow R, eds. The Merck manual of diagnosis and therapy, 17th ed. Whitehouse Station, NJ: Merck & Co.; 1999:1855-75; Owczarek, J., Jasinska, M., Orszulak-Michalak, D., Drug-induced myopathies. An overview of the possible mechanisms (2005) Pharmacol Rep, 57, pp. 23-34; Fernanadez-Sola, J., Cusso, R., Picado, C., Patients with chronic glucocorticoid treatment develop changes in muscle glycogen metabolism (1993) J Neurol Sci, 117, pp. 103-106; Ruff RI. Endocrine myopathies: muscle disorders with adrenal dysfunction. In: Engel AG, Baker BQ, eds. Myology. 2. New York: McGraw-Hill; 1986:1871-900; Kumar, S., Steroid-induced myopathy following a single oral dose of prednisolone (2003) Neurol India, 51, pp. 554-556; Askari, A., Vignos Jr, P.J., Moskowitz, R.W., Steroid myopathy in connective tissue disease (1976) Am J Med, 61, pp. 485-492",
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Atorvastatin-induced early-onset rhabdomyolysis in a patient with nephrotic syndrome. / Jose, J.; Saravu, K.; Shastry, B.A.

In: American Journal of Health-System Pharmacy, Vol. 64, No. 7, 2007, p. 726-729.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Atorvastatin-induced early-onset rhabdomyolysis in a patient with nephrotic syndrome

AU - Jose, J.

AU - Saravu, K.

AU - Shastry, B.A.

N1 - Cited By :12 Export Date: 10 November 2017 CODEN: AHSPE Correspondence Address: Jose, J.; Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; email: jimmy_jose2001@yahoo.com Chemicals/CAS: atorvastatin, 134523-00-5, 134523-03-8; bicarbonate, 144-55-8, 71-52-3; creatine kinase, 9001-15-4; prednisolone, 50-24-8; atorvastatin, 110862-48-1; Heptanoic Acids; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Pyrroles References: Omar, M.A., Wilson, J.P., Cox, T.S., Rhabdomyolysis and HMG-CoA reductase inhibitors (2001) Ann Pharmacother, 35, pp. 1096-1107; [Erratum, Ann Pharmacother. 2001; 35:1296.]; Jamal, S.M., Eisenberg, M.J., Christopoulos, S., Rhabdomyolysis associated with hydroxymethylglutaryl-coenzyme A reductase inhibitors (2004) Am Heart J, 147, pp. 956-965; Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis. N Engl J Med. 2002; 346:539-40. Letter; Omar, M.A., Wilson, J.P., FDA adverse event reports on statin-associated rhabdomyolysis (2002) Ann Pharmacother, 36, pp. 288-295; Antons, K.A., Williams, C.D., Baker, S.K., Clinical perspectives of statin-induced rhabdomyolysis (2006) Am J Med, 119, pp. 400-409; Corsini, A., Bellosta, S., Baetta, R., New insights into the pharmacodynamic and pharmacokinetic properties of statins (1999) Pharmacol Ther, 84, pp. 413-428; [Erratum, Pharmacol Ther. 2000; 86:199.]; Slater, E.E., MacDonald, J.S., Mechanism of action and biological profile of HMG CoA reductase inhibitors. A new therapeutic alternative (1988) Drugs, 36 (SUPPL. 3), pp. 72-82; Flint, O.P., Masters, B.A., Gregg, R.E., Inhibition of cholesterol synthesis by squalene synthase inhibitors does not induce myotoxicity in vitro (1997) Toxicol Appl Pharmacol, 145, pp. 91-98; Folkers, K., Langsjoen, P., Willis, R., Lovastatin decreases coenzyme Q levels in humans (1990) Proc Natl Acad Sci, 87, pp. 8931-8934; Guijarro, C., Blanco-Colio, L.M., Ortego, M., 3-Hydroxy-3-methylglutaryl coenzyme A reductase and isoprenylation inhibitors induce apoptosis of vascular smooth muscle cells in culture (1998) Circ Res, 83, pp. 490-500; Knapp, A.C., Huang, J., Starling, G., Inhibitors of HMG-CoA-reductase sensitize human smooth muscle cells to Fas-ligand and cytokine-induced cell death (2000) Atherosclerosis, 152, pp. 217-227; Pierno, S., De Luca, A., Tricarico, D., Experimental evaluation of the effects of pravastatin on electrophysiological parameters of rat skeletal muscle (1992) Pharmacol Toxicol, 71, pp. 325-329; Igel, M., Sudhop, T., von Bergmann, K., Metabolism and drug interactions of 3-hydroxy-3-methylglutaryl coenzyme A-reductase inhibitors (statins) (2001) Eur J Clin Pharmacol, 57, pp. 357-364; Thompson, P.D., Clarkson, P., Karas, R.H., Statin-associated myopathy (2003) JAMA, 289, pp. 1681-1690; The HMG Co-A reductase inhibitors ('statins') and myotoxic effects. S Afr Med J. 2002; 92:596-7; Ogg, M.S., Williams, J.M., Tarbit, M., A reporter gene assay to assess the molecular mechanisms of xenobiotic-dependent induction of the human CYP3A4 gene in vitro (1999) Xenobiotica, 29, pp. 269-279; El-Sankary, W., Bombail, V., Gibson, G.G., Glucocorticoid-mediated induction of CYP3A4 is decreased by disruption of a protein: DNA interaction distinct from the pregnane X receptor response element (2002) Drug Metab Dispos, 30, pp. 1029-1034; Jamil, S., Iqbal, P., Rhabdomyolysis induced by a single dose of a statin (2004) Heart, 90, pp. e3; Ardati A, Stolley P, Knapp DE et al. Statin-associated rhabdomyolysis. Pharmacoepidemiol Drug Saf. 2005; 14:287. Letter; Savage, R., Tatley, M., Myopathy with statins: Check CK levels and interactions (2004) Prescr Update, 25 (1), pp. 4-5; Graham, D.J., Staffa, J.A., Shatin, D., Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs (2004) JAMA, 292, pp. 2585-2590; Naranjo, C.A., Busto, U., Sellers, E.M., A method for estimating the probability of adverse drug reactions (1981) Clin Pharmacol Ther, 30, pp. 239-245; Brady, H.R., O'Meara, Y.M., Brenner, B.M., Glomerular diseases (2005) Harrison's principles of internal medicine, pp. 1674-1694. , Kasper DL, Braunwald E, Hauser SL et al, eds, 16th ed. New York: McGraw Hill;; Spitalewitz, S., Ponish, J.G., Cattran, D., Treatment of hyperlipidemia in the nephrotic syndrome: The effects of pravastatin therapy (1993) Am J Kidney Dis, 22, pp. 143-150; Biesenbach, G., Zazgornik, J., Lovastatin in the treatment of hypercholesterolemia in nephrotic syndrome due to diabetic nephropathy stage IV-V (1992) Clin Nephrol, 37, pp. 274-279; Olbricht, C.J., Wanner, C., Thiery, J., Simvastatin in nephrotic syndrome (1999) Kidney Int Suppl, 56, pp. S113-S116; Prescott Jr, W.A., Streetman, D.A., Streetman, D.S., The potential role of HMG-CoA reductase inhibitors in pediatric nephrotic syndrome (2004) Ann Pharmacother, 38, pp. 2105-2114; Deak, G., Ruzicska, E., Somogyi, A., Association of IgA nephropathy, hypothyroidism and hypercholesterolemia (2005) J Nephrol, 18, pp. 773-776; Glomerular diseases. In: Beers MH, Berkow R, eds. The Merck manual of diagnosis and therapy, 17th ed. Whitehouse Station, NJ: Merck & Co.; 1999:1855-75; Owczarek, J., Jasinska, M., Orszulak-Michalak, D., Drug-induced myopathies. An overview of the possible mechanisms (2005) Pharmacol Rep, 57, pp. 23-34; Fernanadez-Sola, J., Cusso, R., Picado, C., Patients with chronic glucocorticoid treatment develop changes in muscle glycogen metabolism (1993) J Neurol Sci, 117, pp. 103-106; Ruff RI. Endocrine myopathies: muscle disorders with adrenal dysfunction. In: Engel AG, Baker BQ, eds. Myology. 2. New York: McGraw-Hill; 1986:1871-900; Kumar, S., Steroid-induced myopathy following a single oral dose of prednisolone (2003) Neurol India, 51, pp. 554-556; Askari, A., Vignos Jr, P.J., Moskowitz, R.W., Steroid myopathy in connective tissue disease (1976) Am J Med, 61, pp. 485-492

PY - 2007

Y1 - 2007

N2 - Purpose. A case of early-onset rhabdomyolysis in a patient treated with atorvastatin is described. Summary. A 17-year-old Indian boy weighing 55 kg was admitted to the hospital after complaining of facial puffiness and pedal edema for four days. His medical history revealed a diagnosis of nephrotic syndrome when he was 2 years old. He had six relapses, the last of which occurred 10 years ago. He was not taking any medications on admission and had not for the past 9 years. His vital signs were normal on admission (day 1), but anasarca was noticed during general examination. Cardiovascular, respiratory, and abdominal examinations were normal. Relapse of nephrotic syndrome was considered, and his 24-hour urine protein value confirmed the diagnosis. Further laboratory tests revealed that the patient had high total and low-density-lipoprotein cholesterol values (597 and 465 mg/dL, respectively), and atorvastatin 10 mg p.o. once daily was initiated on day 2. Prednisolone 60 mg p.o. once daily was initiated on day 3. On day 6, the patient complained of pain in both thighs and had difficulty walking. His creatine kinase (CK) concentration was then measured and found to be elevated (11,821 IU/L). Prednisolone and atorvastatin were then stopped, as statin-induced myopathy was suspected. The patient received i.v. hydration and sodium bicarbonate, and he began to show improvement by day 9. Follow-up three weeks later revealed a normal CK level and no myopathy-related complaints. Conclusion. Early-onset rhabdomyolysis was reported in a patient with nephrotic syndrome who was treated with atorvastatin. Concomitant use of prednisolone and the patient's underlying renal impairment may have predisposed the patient to this adverse reaction. Copyright © 2007, American Society of Health-System Pharmacists, Inc. All rights reserved.

AB - Purpose. A case of early-onset rhabdomyolysis in a patient treated with atorvastatin is described. Summary. A 17-year-old Indian boy weighing 55 kg was admitted to the hospital after complaining of facial puffiness and pedal edema for four days. His medical history revealed a diagnosis of nephrotic syndrome when he was 2 years old. He had six relapses, the last of which occurred 10 years ago. He was not taking any medications on admission and had not for the past 9 years. His vital signs were normal on admission (day 1), but anasarca was noticed during general examination. Cardiovascular, respiratory, and abdominal examinations were normal. Relapse of nephrotic syndrome was considered, and his 24-hour urine protein value confirmed the diagnosis. Further laboratory tests revealed that the patient had high total and low-density-lipoprotein cholesterol values (597 and 465 mg/dL, respectively), and atorvastatin 10 mg p.o. once daily was initiated on day 2. Prednisolone 60 mg p.o. once daily was initiated on day 3. On day 6, the patient complained of pain in both thighs and had difficulty walking. His creatine kinase (CK) concentration was then measured and found to be elevated (11,821 IU/L). Prednisolone and atorvastatin were then stopped, as statin-induced myopathy was suspected. The patient received i.v. hydration and sodium bicarbonate, and he began to show improvement by day 9. Follow-up three weeks later revealed a normal CK level and no myopathy-related complaints. Conclusion. Early-onset rhabdomyolysis was reported in a patient with nephrotic syndrome who was treated with atorvastatin. Concomitant use of prednisolone and the patient's underlying renal impairment may have predisposed the patient to this adverse reaction. Copyright © 2007, American Society of Health-System Pharmacists, Inc. All rights reserved.

U2 - 10.2146/ajhp060241

DO - 10.2146/ajhp060241

M3 - Article

VL - 64

SP - 726

EP - 729

JO - American Journal of Health-System Pharmacy

JF - American Journal of Health-System Pharmacy

SN - 1079-2082

IS - 7

ER -