Abstract
Simvastatin as an effective cholesterol-lowering medication is widely prescribed to treat cardiovascular diseases. Despite definite safety and efficacy, myopathy and liver dysfunction are the common adverse effects of simvastatin. Little information is available regarding the symptom starting and recovery period for a patient undergoing the side effect. We present here a 65-year-old male patient with both liver dysfunction and myositis due to the concomitant use of itraconazole 400 mg and simvastatin 40 mg daily.
Highlights
Statin, one kind of the hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, have significant impact on lipid parameters and favorable safety profile in cardiovascular disease, especially in atherosclerotic disease, approximately 9-20% statinstreated patients might develop myopathy which is commonly manifested by myalgias with or without plasma Creatine Kinase (CK) elevations [1,2,3]
It has been demonstrated that HMG-CoA reductase inhibitors are primarily metabolized by the cytochrome P450 [10]
Of the several isoenzymes of the cytochrome P450, simvastatin is metabolized by cytochrome P450 3A4 (CYP3A4) and can interfere the ubiquitin proteasome (coenzyme Q10 (CoQ10)) pathway which primarily maintains the architecture of skeletal muscle [5]
Summary
Myositis and Liver Dysfunction due to Concomitant Therapy of Simvastatin and Itraconazole.
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