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Rhabdomyolysis and Renal Failure Associated with Gemfibrozil Monotherapy

Professor of Medicine, School of Medicine, West Virginia University, Morgantown, WV

Aasim S Sehbai, MD

Fellow, Hematology-Oncology, School of Medicine, West Virginia University

Linda J Stark, MD

Assistant Professor of Medicine, School of Medicine, West Virginia University

Reprints: Richard D Layne MD, School of Medicine, West Virginia University, PO Box 9160, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506-9160, fax 304/293-2544, rlayne{at}hsc.wvu.edu

OBJECTIVE: To report a case of rhabdomyolysis and acute renal failure associated with gemfibrozil monotherapy of hyperlipidemia.

CASE SUMMARY: A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia was hospitalized due to myalgias, nausea, and vomiting that began after he started working as a jackhammer operator 4 days previously. His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which previously had been mildly elevated and normal, respectively, were markedly elevated, consistent with rhabdomyolysis with acute renal failure.

DISCUSSION: As of December 8, 2003, this is the only report of a patient with normal baseline creatinine level who developed rhabdomyolysis with acute renal failure associated with gemfibrozil monotherapy. Strenuous exertion, hypovolemia, and lisinopril use may have contributed to the severity of illness. An objective causality assessment revealed that an adverse drug reaction to gemfibrozil was possible.

CONCLUSIONS: Gemfibrozil monotherapy of hyperlipidemia may predispose to rhabdomyolysis with acute renal failure. Patients using gemfibrozil should be cautioned regarding strenuous exertion, dehydration, and the need for prompt evaluation of myalgias.

Key Words: acute kidney failure, angiotensin-converting enzyme inhibitors, gemfibrozil, rhabdomyolysis

Published Online, December 15, 2003. www.theannals.com, DOI 10.1345/aph.1D282

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