Abstract
BackgroundRhabdomyolysis is a rare but serious complication of lipid-lowering therapy. Statin and fibrate combination increases the risk of rhabdomyolysis possibly by pharmacodynamic interactions. Advanced age, diabetes, hypothyroidism, polypharmacy, and renal impairment are known to increase the risk of rhabdomyolysis. Management strategies include fluid resuscitation and urine alkalinization. Renal indications such as refractory hyperkalemia, acidosis, fluid overload, or uremic complications mandate renal replacement therapy in rhabdomyolysis.Case presentationWe report the case of a 62-year-old Sri Lankan Sinhalese man with dyslipidemia, type 2 diabetes mellitus with renal impairment, and hypothyroidism who was on atorvastatin; he was started on gemfibrozil and developed muscle symptoms. Although gemfibrozil was discontinued soon after, he presented with rhabdomyolysis with acute kidney injury 1 month later. He needed hemodialysis due to refractory hyperkalemia, metabolic acidosis, and fluid overload.ConclusionsRhabdomyolysis is a rare but serious complication due to lipid-lowering therapy with statins and fibrates. Treating physicians should be aware and patients should be warned to report about muscle symptoms after starting statins or fibrates. Rhabdomyolysis may occur with mild symptoms and signs and may occur later, even after discontinuation of the drug.
Highlights
Rhabdomyolysis is a rare but serious complication of lipid-lowering therapy
Treating physicians should be aware and patients should be warned to report about muscle symptoms after starting statins or fibrates
Diabetes, renal impairment, hypothyroidism, and type and higher doses of statins are recognized as important risk factors of rhabdomyolysis [13,14,15,16,17,18,19,20,21,22,23,24,25,26]
Summary
Rhabdomyolysis is a rare but serious side effect of statin monotherapy and more common in combination therapy of statin and fibrate. Rhabdomyolysis may occur with minimum clinical symptoms and signs, even many weeks after discontinuation of therapy. Treating physicians should be more cautious in prescribing statins or combination therapy of statin and fibrates in those with risk factors and should discuss signs and symptoms of muscle toxicity with patients in order to prevent rhabdomyolysis. Ethics approval and consent to participate Ethical approval was not obtained for the publication of this case report as this does not involve sharing of the personal details of the patient. Consent for publication Written informed consent was obtained from the patient for publication of this case report. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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