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Elevated Creatine Kinase and Myalgia in a Patient Taking Rosiglitazone

Primary Care Pharmacist; Assistant Professor, Department of Family and Community Medicine Health Centre, St. Michael's Hospital, Toronto, Ontario, Canada

Tony Antoniou, PharmD

Clinical Pharmacy Specialist St. Michael's Hospital Department of Family and Community Medicine

Philip Berger, MD

Chief, Department of Family and Community Medicine, St. Michael's Hospital

Reprints: Dr. Kennie, Department of Family and Community Medicine Health Centre, St. Michael's Hospital, 410 Sherbourne St., 4th Floor, Toronto, ON M4X 1K2, Canada, fax 416/867-3726, natalie.kennie{at}utoronto.ca

OBJECTIVE: To report a case of rosiglitazone-associated elevation in creatine kinase (CK) and coexisting myalgias and review other cases identified in the literature.

CASE SUMMARY: A 42-year-old man originally from Sri Lanka developed an elevated CK, with peak concentrations of 1671 U/L (normal <160) and myalgias following 5 months of therapy with rosiglitazone. Signs and symptoms recurred upon rechallenge 3 years later. Other potential medical and medication causes were ruled out. Independent assessment by 2 raters using the Naranjo probability scale suggested a probable relationship with rosiglitazone.

DISCUSSION: Only 5 previous reports of elevated CK, myalgias, myopathy, or rhabdomolysis in patients taking rosiglitazone or other thiazolidinediones were identified in the literature. Potential risk factors identified from previously published reports included concomitant therapy with fibrates, excessive use of ethanol, and asymptomatic mild CK elevation prior to starting therapy. Based on this case report, it seems reasonable to monitor CK levels in patients on rosiglitazone who are experiencing muscle symptoms or who have a history of myopathy.

CONCLUSIONS: Marked elevations of CK and muscle pain may be a possible adverse reaction of rosiglitazone therapy.

Key Words: creatine kinase, myalgia, rosiglitazone

Published Online, February 27, 2007. www.theannals.com, DOI 10.1345/aph.1H609

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