Atorvastatin and sildenafil interaction-induced rhabdomyolysis
Abstract
Rhabdomyolysis with the concomitant use of phosphodiesterase-5 (PDE5) inhibitors and statins have previously been reported for simvastatin and rosuvastatin.1,2 We present here the first case of atorvastatin/sildenafil-induced rhabdomyolysis, and we discuss the possible mechanisms of this drug interaction. A 44-year-old man who had been taking atorvastatin 10 mg daily for 4 years for hypercholesterolemia presented at the hospital with severe and unexplained muscle aches, particularly in the lower part of his legs and feet. The problem had started within 3 days of taking on his own a 100-mg dose of sildenafil daily (cumulative dose 300 mg), and the patient was admitted 2 days later. The patient was also treated with captopril and metformin. There had been no trauma prior to the onset of symptoms. He had no history of neuromuscular disorders, alcoholism, or drug abuse. He denied also any unusual or abnormal physical activity, burns or recent intramuscular injections, or symptoms of coronary artery disease. His creatine phosphokinase level was highly raised at 95 569 U/L (>30× upper limit of normal). A thyroid checkup, an electrocardiogram, and an abdominal ultrasound were normal. C-reactive protein and the blood count were also normal. Atorvastatin was withdrawn. The patient received symptomatic treatment. Levels of creatine kinase decreased to near-normal levels within 13 days (creatine kinase (CPK) 357 U/L). The renal function remained unaffected throughout the course and…
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