Maximal initiative dose of simvastatin causing acute renal failure through rhabdomyolysis: Risk factors, pathomechanism and therapy related to a case

Abstract

Abstract Rhabdomyolysis (RML) is a rare and severe adverse effect of simvastatin (SIM). Several risk factors were described to play a role in its pathogenesis, namely age > 65, diabetes mellitus, renal disease, high dose statin therapy, chemicals metabolized by cytochrome P450 3A4 or idiosyncrasia. Case summary A 66-year-old man with diabetes, ischaemic heart disease and hypertension, on medication of CYP3A4 substrates amlodipine and alprazolam, maximal daily dose of SIM started for unknown cholesterol level. On the second day dark-brown urine, paraparesis, bile-like vomiting, on the fourth day of treatment total tetraparesis and oliguria characterized RML with acute renal failure. During his hospitalization of one-hundred-six days he underwent fourty-nine dialysis treatments. At the follow-up sixteen months after exmission from hospital, his walking improved to using one stick. His cholesterol level is in the physiological range with no statin therapy. Conclusions On account of risk factors listed above this case should have been administered low initial dose of SIM. On developing myalgia or weakness in muscles, treatment must be stopped. In a case of predisposition to RML statin therapy and dosage can only be performed under continuous supervision.