Rhabdomyolysis caused by the moderate CYP3A4 inhibitor fluconazole in a patient on stable atorvastatin therapy: a case report and literature review

• Published in: Journal of clinical pharmacy and therapeutics Vol. 41; no. 5; pp. 575 - 578
• Main Authors: Hsiao, S.‐H., Chang, H.‐J., Hsieh, T.‐H., Kao, S.‐M., Yeh, P.‐Y., Wu, T.‐J.
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.10.2016
• Subjects: Aged; atorvastatin; Atorvastatin Calcium - adverse effects; Cytochrome P-450 CYP3A Inhibitors - adverse effects; drug interaction; Drug Interactions; Female; fluconazole; Fluconazole - adverse effects; Humans; rhabdomyolysis; Rhabdomyolysis - chemically induced; fluconazole; rhabdomyolysis; atorvastatin; drug interaction
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12425

Summary What is known and objective Rhabdomyolysis is a severe potential adverse drug reaction of statin therapy. We report a case of rhabdomyolysis due to drug–drug interaction (DDI) between atorvastatin and fluconazole and review the literature. Case summary A 70‐year‐old woman received atorvastatin for hyperlipidaemia without any problem for 4 years. When intravenous fluconazole was added for treating a fungal infection, rhabdomyolysis developed 2 weeks later. Removal of atorvastatin led to the resolution of her rhabdomyolysis. What is new and conclusion Our case demonstrates that in some subjects even a moderate CYP3A4 inhibitor such as fluconazole may lead to rhabdomyolysis in subjects receiving a statin. Characteristics of reported cases of rhabdomyolysis associated with drug interaction between statins and fluconazole.