Severe rosuvastatin accumulation with rhabdomyolysis due to drug interactions and low cardiac output syndrome

Abstract

An 85-year-old patient presented to the emergency department because of orthopnoea and peripheral oedema. He was known for diabetes mellitus and coronary artery disease with severe chronic heart failure. Eighteen months earlier, he already showed biventricular dilatation and systolic dysfunction (20-25% left ventricular ejection fraction) with moderate mitral valve regurgitation at transthoracic echocardiography. On current physical examination, he showed moderate oedema of the legs. On chest X-ray, there was upper lobe pulmonary venous congestion and small bilateral pleural effusion. Laboratory testing revealed moderate creatinine elevation (150 μmol L −1 ; normal <107). Liver enzymes and creatine kinase levels were normal. The patient's daily therapy consisted of acetylsalicylic acid 100 mg, metoprolol 50 mg, sacubitril/valsartan 200 mg (97/103 mg), torasemide 10 mg,

A Rare Adverse Event of Rhabdomyolysis Caused by Sacubitril/Valsartan

“…Though rhabdomyolysis is listed as a potential adverse drug reaction to Entresto™, there have been no case reports of Entresto™ as being the sole cause of severe rhabdomyolysis. Recently two case reports have reported a similar clinical scenario except for the fact that these patients were also on concomitant statin therapy [6,7]. However, we report a patient here who was not on concurrent statin therapy or any other drugs known to cause rhabdomyolysis.…”

Detection of muscular system adverse reaction signals in sacubitril/valsartan treatment combined with statins

“…This may be related to the smaller impact of inhibition of OATP1B1 and OATP1B3 on the AUC of rosuvastatin ( Elsby et al, 2012 ). In the existing literature are five case reports of rhabdomyolysis caused by the combined use of sacubitril/valsartan and statins, four of which were associated with atorvastatin ( Faber et al, 2016 ; Chan KH et al, 2020 ; Siew et al, 2022 ; Zhao FK et al, 2022 ) and one with rosuvastatin ( Previsdomini et al, 2019 ). However, the present study did not detect a statistically significant association signal with rhabdomyolysis, consistent with findings from studies like ( Sunaga and Ryo 2021 ; Tomiko and Yonezawa, 2021 ).…”

Approaches to management of rhabdomyolysis as the adverse effect of drug interaction between atorvastatin and sacubitril/valsartan: a case report

“…Several case reports have described similar risk factors and the presentation of rhabdomyolysis soon after the addition of sacubitril/valsartan. 8–10 Rawla et al . 11 had recorded a case with similar underlying risk factors for rhabdomyolysis reported sacubitril/valsartan as the only drug that could account for rhabdomyolysis ( Table 2 ).…”