Severe Rhabdomyolysis Associated With Low-Dose Isotretinoin Therapy

Morgado‐Carrasco, Daniel; Rosario, A. del; Fustà‐Novell, Xavier; Giavedoni, Priscila

doi:10.1016/j.adengl.2018.08.006

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Transaminitis, specifically a significant elevation of AST, has been associated with rhabdomyolysis in the absence of any significant liver injury and, as with our patient, the elevated AST resolves as the CK decreases [ 11 , 12 ]. Previous reviews have identified elevations in CK in patients taking isotretinoin, though these elevations are generally mild, unlike this patient who experienced a CK increase of more than 100 times the upper limit of normal [ 10 , 13 - 15 ]. Sixty percent of rhabdomyolysis cases are found to have at least two contributing factors and CK elevations may synergistically increase in the setting of exercise and isotretinoin treatment [ 5 , 14 ].…”

Section: Discussionmentioning

confidence: 88%

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Rhabdomyolysis Caused by Isotretinoin and Exercise in an Otherwise Healthy Female Patient

Raneses¹,

Schmidgal²

2022

Cureus

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Acne vulgaris is one of the most common skin conditions treated by healthcare providers. Isotretinoin is a well-known and effective treatment for nodulocystic and scarring acne. Rarely, and usually in combination with exercise, patients treated with isotretinoin can develop rhabdomyolysis, a potentially life-threatening breakdown of muscle associated with elevated creatine kinase (CK). Here, we report a rare case of a female patient developing rhabdomyolysis three months after starting exercise and isotretinoin. She was treated with supportive care and medication was discontinued, resulting in a full recovery. Careful inquiry into the patient's exercise habits, along with a thorough review of systems at each visit can help identify high-risk patients. Routine monitoring of liver enzymes, specifically aspartate aminotransferase elevations, may provide a prompt to check a patient’s CK. Though regular monitoring of CK is not currently recommended, given the prevalence of regular exercise in certain patient populations, this case reinforces the importance of counseling patients on this potential side effect.

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Section: Discussionmentioning

confidence: 88%

“…It has been reported that taking lower doses can be efficacious and have a lower incidence of severe side effects [ 17 ]. However, there has been a report of a patient that developed rhabdomyolysis on a low-dose regime as well [ 15 ]. Finally, our patient is an active duty military member.…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis Caused by Isotretinoin and Exercise in an Otherwise Healthy Female Patient

Raneses¹,

Schmidgal²

2022

Cureus

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“…Isotretinoin has been associated with a range of musculoskeletal side‐effects, including precipitation of acne fulminans, arthralgia, Achilles tendonitis, 72 myalgia without CK elevation, and hyperCKaemia, both with and without development of rhabdomyolysis 47,73–82 …”

Section: Methodsmentioning

confidence: 99%

“…Isotretinoin has been associated with a range of musculoskeletal side-effects, including precipitation of acne fulminans, arthralgia, Achilles tendonitis, 72 myalgia without CK elevation, and hyperCKaemia, both with and without development of rhabdomyolysis. 47,[73][74][75][76][77][78][79][80][81][82] Myalgia and mild transient elevations in CK are common, and were observed in 20% of patients in a small series. 47 Significant elevations are much less frequent, with Manfredini et al 73 detecting CK over five times the upper reference range in 1Á2% of patients, and Landau et al 81 noting CK > 5000 IU L À1 in 1Á6% of patients (although Landau's was a military population).…”

Section: Evidence Foundmentioning

confidence: 99%

“…81 Conversely, severe myalgia with significant proximal weakness or stiffness has been reported with minimal change in CK levels, 78,87 although there may be a role for L-carnitine in these symptoms. 88 Our literature review identified eight cases of rhabdomyolysis secondary to isotretinoin, [74][75][76]79,80,82,89,90 with one fatality. 79 This has occurred with as little as 20-mg daily dosing, although patients often note recent vigorous exercise as a potential trigger.…”

Section: Evidence Foundmentioning

confidence: 99%

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Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Affleck

Jackson

Williams

et al. 2022

British Journal of Dermatology

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Summary Clinical question Is monitoring of liver function, lipids and full blood count necessary in healthy people taking isotretinoin? Background Routine blood testing was recommended in the original licence for Roaccutane™ (isotretinoin) in 1983. In recent years, less frequent monitoring has been suggested by various authors. Data sources We performed four individual systematic searches of the MEDLINE database, via PubMed, from origin to 2 May 2021, supplemented by a hand search of all references in the identified papers. Study selection Inclusion criteria were any description of clinical symptoms, laboratory abnormalities and/or physical findings, and any paper that explicitly described the patients as asymptomatic, during treatment with oral isotretinoin. Data extraction Two independent reviewers (J.A. and D.J.) assessed articles for eligibility of inclusion. Evaluation of the data was done also by two of the authors (A.A., D.J. and J.A.) for each section, with the aim to use the presented evidence including guidelines, databases, case series, case reports, cohort studies and randomized clinical trials to delineate the clinical presentation and frequency of adverse events that might be amenable to laboratory monitoring. Results We identified 407 papers in our searches and reviewed 125 papers in four sections. Overall, reported adverse events were very rare (< 1 in 10 000) and were either idiosyncratic or not preventable by monitoring, accompanied by symptoms, or seen in identifiable predisposed individuals who might benefit from monitoring because of pre‐existing conditions. Recommendation for clinical care We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting nonserious biochemical abnormalities. However, we recognize that new information about adverse events may change that recommendation.

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Isotretinoin

2020

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Severe Rhabdomyolysis Associated With Low-Dose Isotretinoin Therapy

Cited by 4 publications

References 14 publications

Rhabdomyolysis Caused by Isotretinoin and Exercise in an Otherwise Healthy Female Patient

Rhabdomyolysis Caused by Isotretinoin and Exercise in an Otherwise Healthy Female Patient

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Isotretinoin

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