Clopidogrel-Precipitated Rhabdomyolysis in a Stable Heart Transplant Patient

Abstract

Practitioners must be conscious of the potential for adverse effects when prescribing clopidogrel to heart transplant patients who are concomitantly receiving cyclosporine and a statin. If concomitant administration is required, careful clinical and laboratory monitoring of the patient is necessary.

Rhabdomyolysis in a patient receiving ranolazine and simvastatin

“…Similarly, simvastatin, clopidogrel, isosorbide mononitrate, omeprazole, and ranolazine are substrates for CYP3A and may have been competing for the enzyme. Burton et al 9 described the development of rhabdomyolysis in a heart transplant recipient taking clopidogrel and statin therapy. They attributed her rhabdomyolysis to the drugs' competitive inhibition of CYP3A.…”

Rhabdomyolysis induced acute renal failure secondary to statins

“…This process results in metabolism of the drug that successfully accesses the catalytic sites of the enzyme, whereas the excluded drug is metabolized at a significantly slower rate. [1112] In the present patient there were three drugs which might have competed for the hepatic CYP450 3A4 enzyme. The metabolism of atorvastatin might have been slowed.…”

Rhabdomyolysis after Transplantation: Case Report after Allogeneic Hematopoietic Transplantation and Review of Literature

“…Twenty cases of rhabdomyolysis have been reported after solid organ transplantation [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], 2 cases after allogeneic hematopoietic stem cell transplantation [5,6] while 5 cases of rhabdomyolysis occurred in patients assuming cyclosporine for other clinical reasons [7,[43][44][45][46]. In heart transplant recipients treated with statins, frequency of myopathy was estimated between 10% and 20% [47], while in a retrospective study of patients who underwent marrow transplant and were treated with statins, myopathy was found in 1% [13].…”

“…The incidence of rhabdomyolysis is also increased by the concomitant use of statins metabolized by CYP3A4 together with agents that inhibit CYP3A4, such as azoles, verapamil, diltiazem, amiodarone, protease inhibitors, fibrate, tricyclic antidepressants, midazolam, tamoxifen and macrolides [8,22]. Accordingly, in 9 out of the 22 case reports of myopathy occurring as an adverse effect of statins after transplantation [5,6, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], the patients receiving a statin and cyclosporine were also treated concomitantly with agents inhibiting CYP3A4, as follows: risperidone (1 case), verapamil (1 case), macrolides (1 case), itraconazole (1 case), clopidogrel (1 case), fibrate (1 case), fusidic acid (1 case), gemfibrozil (1 case) and multiple agents (1 case). In the other 13 cases, rhabdomyolysis was associated with the concomitant use only of cyclosporine and statins.…”