QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shaukat, A. Articles by Baer, M. R Search for Related Content PubMed PubMed Citation Articles by Shaukat, A. Articles by Baer, M. R

Simvastatin–Fluconazole Causing Rhabdomyolysis

Clinical Instructor, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY

Mustafa Benekli, MD

Clinical Fellow, Roswell Park Cancer Institute, Buffalo

Georgirene D Vladutiu, PhD

Professor of Pediatrics, Neurology and Pathology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Director, The Robert Guthrie Biochemical Genetics Laboratory, Children's Hospital of Buffalo, Buffalo

James L Slack, MD

Assistant Professor, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Staff Physician, Leukemia Section, Department of Medicine, Roswell Park Cancer Institute

Meir Wetzler, MD

Associate Professor, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Staff Physician; Leukemia Section, Department of Medicine, Roswell Park Cancer Institute

Maria R Baer, MD

Professor, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Chief, Leukemia Section, Department of Medicine, Roswell Park Cancer Institute

Reprints: Aasma Shaukat MD MPH, Department of Medicine, Erie County Medical Center, 462 Grider St., Buffalo, NY 14215-3098, FAX 716/898-3279, E-mail medasha{at}acsu.buffalo.edu

OBJECTIVE: To report a case of rhabdomyolysis after concomitant use of simvastatin, a commonly used hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, and fluconazole, an azole antifungal agent.

CASE SUMMARY: An 83-year-old white man with a history of congestive heart failure and hyperlipidemia presented to the hospital 1 week following the addition of fluconazole to a medication regimen that included simvastatin 40 mg once daily. The patient had severe muscle weakness and a markedly elevated serum creatine kinase activity, which resolved following discontinuation of simvastatin and fluconazole.

DISCUSSION: Rhabdomyolysis is a recognized adverse effect of HMG-CoA reductase inhibitors (statins), commonly caused by their interaction with other drugs, such as azole antifungals, that inhibit the cytochrome P450 isoenzyme family. An objective causality assessment revealed that the adverse drug event was probable. Although drug interactions have been described for combinations of other HMG-CoA reductase inhibitors and azole antifungals, rhabdomyolysis likely caused by the interaction between simvastatin and fluconazole has not yet been reported. This case reinforces the importance of being vigilant for drug interactions, particularly in connection with commonly prescribed medications such as statins.

CONCLUSIONS: Patients receiving statins who have cancer may receive azole antifungals and other drugs that inhibit CYP3A4 during treatment, predisposing them to toxicity. These patients should therefore be monitored closely for drug interactions.

Key Words: fluconazole, HMG-CoA reductase inhibitors, rhabdomyolysis, simvastatin

Published Online, June 5, 2003. www.theannals.com, DOI 10.1345/aph.1C467

This article has been cited by other articles:

				T. Morera, G. Gervasini, J. A Carrillo, and J. Benitez Using a Computerized Drug Prescription Screening System to Trace Drug Interactions in an Outpatient Setting Ann. Pharmacother., July 1, 2004; 38(7): 1301 - 1306. [Abstract] [Full Text] [PDF]

				E. V. HERSH and P. A. MOORE Drug interactions in dentistry: The importance of knowing your CYPs J Am Dent Assoc, March 1, 2004; 135(3): 298 - 311. [Abstract] [Full Text] [PDF]