Abstract
Simvastatin is among the most commonly used prescription medications for cholesterol reduction and the most common statin-related adverse drug reaction is skeletal muscle toxicity. Multiple factors have been shown to influence simvastatin-induced myopathy. In addition to age, gender, ethnicity, genetic predisposition, and dose, drug-drug interactions play a major role. This is particularly true for drugs that are extensively metabolized by cytochrome P450 (CYP)3A4. We describe a particularly severe case of rhabdomyolysis after the introduction of ciprofloxacin, a weak CYP3A4 inhibitor, in a patient who previously tolerated the simvastatin-amlodipine combination.
Highlights
Severe rhabdomyolysis with statin therapy remains rare, in comparison with myalgias or mild elevation of muscular enzymes
We are reporting a case of impressive rhabdomyolysis occurring soon after the introduction of antimicrobial therapy in patient who acquired peritoneal dialysis-related peritonitis
The patient had a residual creatinine clearance of 5 mL/min. She was diagnosed with a peritoneal dialysis-related peritonitis (PDRP) based on the cloudy aspect of the peritoneal dialysis effluent (PDE) with 1,300 cells/μL and 47% neutrophils. She was at this time poorly symptomatic with no fever or abdominal discomfort and was given empiric antimicrobial therapy with vancomycin 2,000 mg/3d, ciprofloxacin 500 mg b.i.d., and a single dose of gentamicin 80 mg according to our protocol [1]
Summary
Severe rhabdomyolysis with statin therapy remains rare, in comparison with myalgias or mild elevation of muscular enzymes. We are reporting a case of impressive rhabdomyolysis occurring soon after the introduction of antimicrobial therapy in patient who acquired peritoneal dialysis-related peritonitis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
