Fatal rhabdomyolysis in a patient with liver cirrhosis after switching from simvastatin to fluvastatin

• Published in: Journal of Korean medical science Vol. 26; no. 12; pp. 1634 - 1637
• Main Authors: Baek, Seung Don, Jang, Sun-Joo, Park, So-Eun, Ok, Tae Jin, Leem, Jaechan, Lee, Ho-Su, Park, So Jung, Kim, Tae Hee
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.12.2011; 대한의학회
• Subjects: Case Report; Coronary Artery Disease - complications; Coronary Artery Disease - drug therapy; Fatal Outcome; Fatty Acids, Monounsaturated - administration & dosage; Fatty Acids, Monounsaturated - adverse effects; Fatty Acids, Monounsaturated - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Indoles - administration & dosage; Indoles - adverse effects; Indoles - therapeutic use; Liver Cirrhosis - complications; Male; Middle Aged; Rhabdomyolysis - chemically induced; Simvastatin - administration & dosage; Simvastatin - therapeutic use; 의학일반; Fluvastatin; Liver Cirrhosis; Rhabdomyolysis; Simvastatin
• DOI: 10.3346/jkms.2011.26.12.1634
• ISSN: 1011-8934

HMG-CoA reductase inhibitors (statins) are widely used to treat hypercholesterolemia. Among the adverse effects associated with these drugs are statin-associated myopathies, ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis. Fluvastatin-induced fatal rhabdomyolysis has not been previously reported. We describe here a patient with liver cirrhosis who experienced fluvastatin-induced fatal rhabdomyolysis. This patient had been treated with simvastatin (20 mg/day) for coronary artery disease and was switched to fluvastatin (20 mg/day) 10 days before admission. He was also taking aspirin, betaxolol, candesartan, lactulose, and entecavir. Rhabdomyolysis was complicated and continued to progress. He was treated with massive hydration, urine alkalization, intravenous furosemide, and continuous renal replacement therapy for acute renal failure, but eventually died due to rhabdomyolysis complicated by hepatic failure. In conclusion, fluvastatin should be used with caution in patients with liver cirrhosis, especially with other medications metabolized with CYP2C9.