Rhabdomyolysis in an elderly multitreated patient: Multiple drug interactions after statin withdrawal

摘要: Rhabdomyolysis precipitated by multitherapy is most frequently described during statin treatment, due to impairment of clearance drugs sharing cytochrome P450 biotransformation pathway. Modulation membrane transporters for drug efflux, operated substrates, can also affect drugs' tissue levels. We report rhabdomyolysis in an elderly patient, multitreatment with different potentially myotoxic medications, taking place seven months after atorvastatin discontinuation. Affected ischaemic heart disease, arterial hypertension and dementia-related behaviour disturbances, the patient was receiving angiotensin 2-receptor inhibitors, beta-blockers, vasodilators, diuretics, salycilates, allopurinol, proton pump antipsychotics antidepressants. He had taken 14 years, constantly normal creatine-kinase plasma Two addition antianginal ranolazine, mildly increased withdrawn. Nonetheless, progressively rose, severe weakness developing later. Muscle biopsy showed a necrotizing myopathy no inflammation or autoimmune changes. After ranolazine withdrawal, myoglobin returned levels strength restored. Several psychotropic cardiovascular medications prescribed share either permeability-glycoprotein efflux transport. In event cardiovascular/neuropsychiatric polypharmacy geriatric patients, risk muscle adverse effects from pharmacokinetic drug-drug interaction should be considered beyond direct myotoxicity statins.