Rhabdomyolysis in a Patient Treated with Colchicine and Atorvastatin

Tufan, Abdurrahman; Dede, Didem Şener; Cavus, Safak; Altıntaş, Neriman Defne; İskit, Alper B.; Topeli, Arzu

doi:10.1345/aph.1h064

Cited by 63 publications

(53 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, clinically significant DDIs have been reported with atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin when used in combination with colchicine. [170][171][172][173][174][175][176][177][178][179][180][181][182] The DDI between colchicine and simvastatin is the most frequently reported in the literature, having been the subject of 6 cases. In each case, simvastatin-colchicine combination therapy resulted in myopathy, and 1 case progressed to rhabdomyolysis, multiorgan failure, and death.…”

Section: Miscellaneous Agents Colchicinementioning

confidence: 99%

Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Wiggins¹,

Saseen²,

Page³

et al. 2016

Circulation

247

194

View full text Add to dashboard Cite

A drug-drug interaction (DDI) is a pharmacokinetic or pharmacological influence of 1 medication on another that differs from the known or anticipated effects of each agent alone.1 A DDI may result in a change in either drug efficacy or drug toxicity for 1 or both of the interacting medications.2 Pharmacokinetic DDIs result in altered absorption, distribution, metabolism, or excretion of a medication. A pharmacodynamic DDI occurs when 1 medication modifies the pharmacological effect of another in an additive, a synergistic, or an antagonistic fashion.It is estimated that ≈2.8% of hospital admissions occur as a direct result of DDIs. 3 However, the actual incidence of hospitalization secondary to clinically significant DDIs is likely to be highly underestimated because medication-related issues are more commonly reported as adverse drug reactions. Complex underlying disease states also may make recognizing a DDI more challenging, further contributing to a lower reported incidence. The overall clinical impact of a DDI can range from mild to life-threatening. Therefore, not all DDIs require a modification in therapy. The variability in the clinical significance of a DDI depends on both medication-specific and patient-specific factors. Medication-specific factors include the individual pharmacokinetic characteristics of each medication implicated in the DDI (eg, binding affinity, half-life [t 1/2 ]), dose of the medications, serum concentrations, timing and sequence of administration, and duration of therapy. Patient-specific factors include age, sex, lifestyle, genetic polymorphisms causing differences in enzyme expression or activity, and disease impairment affecting drug metabolism (eg, hepatic or renal impairment, cardiac failure) or predisposition to differences in efficacy or safety (eg, statin intolerance in patients with a history of myopathy). Clinically significant DDIs are usually preventable. To optimize patient safety, healthcare providers must have an understanding of the mechanisms, magnitude, and potential consequences of any given DDI. Interpreting this information will assist clinicians in the safe prescribing of medications and permits careful consideration of the benefits and risks of concomitant medications.Statins reduce morbidity and mortality in patients with known atherosclerotic cardiovascular disease (ASCVD) and in many primary prevention patients.4-9 Current guidelines recommend high-intensity statin therapy in all patients with ASCVD age ≤75 years and moderate-to high-intensity statin therapy in patients with ASCVD and age >75 years, diabetes mellitus, and familial hypercholesterolemia and in primary prevention patients with 10-year ASCVD risk ≥7.5%.10 Given the important role of statins in patients with ASCVD and those at high ASCVD risk, combination therapy with statins and other cardiovascular medications is highly likely, and potentially significant DDIs must be considered in patients treated with statins.Another important aspect of prescribing medications in combination is evalu...

show abstract

Section: Miscellaneous Agents Colchicinementioning

confidence: 99%

Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Wiggins¹,

Saseen²,

Page³

et al. 2016

Circulation

247

194

View full text Add to dashboard Cite

show abstract

“…91 There is increased risk of myopathy/rhabdomyolysis with atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin. 92 …”

mentioning

confidence: 99%

Management of Gout and Hyperuricemia in CKD

Vargas-Santos

Neogi

2017

American Journal of Kidney Diseases

151

104

View full text Add to dashboard Cite

Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). While the presence of CKD poses additional challenges in gout management, effective urate-lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, while incremental dose escalation is guided by regular monitoring of serum urate to reach the target of less than 6 mg/dL (or less than 5 mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbidities. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.

show abstract

“…Only one such interaction was detected. Increased risk of myelotoxic effects-myopathy and varying degrees of rhabdomyolysis, are observed in patients taking statins with colchicine [16]. The possible mechanisms involved in this interaction are complex and are most likely to be at both pharmacokinetic and pharmacodynamic levels.…”

Section: Discussionmentioning

confidence: 99%

Potential Drug-Drug Interactions in Heart Failure Patients

Georgiev

Hvarchanova

Georgieva

et al. 2019

Int J Pharm Pharm Sci

View full text Add to dashboard Cite

Objective:The aim of the present study was to assess the prevalence, risk rating and the severity of hazardous pDDIs (potential drug-drug interactions) in the prescribed pharmacotherapy in the hospital discharged heart failure (HF) patients, primarily with co-administered drugs with narrow therapeutic index (statins, anticoagulants, antithrombotic drugs). Methods:The prescriptions of chronic heart failure patients for one year (January-December 2014) were analyzed for pDDIs through Lexi-interact ® software. DDIs belonging to the categories D (Consider therapy modification) and X (Avoid combination) and/or severity of drug interaction-major, were selected for the study.Results: After reviewing the medical records of 985 patients, 239 patients were selected based on the criteria mentioned above. The average number of prescription drugs at hospital discharge was 7.27 medications (±1.84 SD) per patient. The total number of pDDIs was 1483 or approximately 6.2 (±3.89 SD) pDDIs per patient. With respect to the risk rating, in categories D and X were detected 76 (5.12 %) and 2 (0.13 %) pDDI, respectively. The major pDDIs were 108 (7.28 %).Conclusion: HF patients are at high risk of pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.

show abstract

Rhabdomyolysis in a Patient Treated with Colchicine and Atorvastatin

Abstract: We recommend checking the creatine kinase level one week after prescribing 2 or more potentially myotoxic drugs concomitantly, after dose increase of a myotoxic drug, or after prescribing a new drug to a patient already using other myotoxic agents.

Cited by 63 publications

References 15 publications

Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Management of Gout and Hyperuricemia in CKD

Potential Drug-Drug Interactions in Heart Failure Patients

Contact Info

Product

Resources

About