Approaches to management of rhabdomyolysis as the adverse effect of drug interaction between atorvastatin and sacubitril/valsartan: A case report

Siew, Kelvin Shenq Woei and Abdul Hafidz, Muhammad Imran and Mohd Zaidan, Fatimah Zahrah and Hadi, Mohd Firdaus (2022) Approaches to management of rhabdomyolysis as the adverse effect of drug interaction between atorvastatin and sacubitril/valsartan: A case report. European Heart Journal - Case Reports, 6 (3). ISSN 2514-2119, DOI

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Background: Atorvastatin and sacubitril/valsartan (Entresto™) have been cornerstones in managing patients with coronary artery disease and heart failure (HF). We report a case of life-threatening rhabdomyolysis associated with the co-administration of atorvastatin and sacubitril/valsartan. Case summary: A 58-year-old male with coronary heart disease and chronic HF treated with the optimal dose of atorvastatin and other cardiovascular medications was frequently admitted for acute decompensation of HF. We decided to optimize his condition by adding sacubitril/valsartan to his treatment regime. He presented to our outpatient clinic with worsening myalgia and oliguria 6 days later. He was readmitted with markedly elevated serum creatinine kinase (CK) (94 850 U/L; normal range 32-294 U/L), deranged liver function tests, and acute kidney injury. We withheld atorvastatin and sacubitril/valsartan and treated him with renal replacement therapy. Discussion: Sacubitril inhibits the excretion of statins, thereby elevating serum statin concentration and increasing the likelihood of developing muscle-related toxicity. Co-administration of atorvastatin and sacubitril/valsartan should be monitored closely with laboratory investigations of CK and liver and renal function. The physician may consider starting low-dose atorvastatin at 20 mg daily in combination with sacubitril/valsartan 24 mg/26 mg twice daily and titrating accordingly to optimal doses. Rosuvastatin could be an alternative to atorvastatin, as it has less drug-drug interaction with sacubitril, thereby reducing the adverse effect. © 2022 The Author(s).

Item Type: Article
Funders: None
Uncontrolled Keywords: Acetylsalicylic acid; Alanine aminotransferase; Aspartate aminotransferase; Atorvastatin; Bisoprolol; Creatine kinase; Dobutamine; Fondaparinux; Furosemide; Perindopril; Potassium; Rosuvastatin; Sacubitril plus valsartan; Spironolactone; Ticagrelor; Troponin I; Acute coronary syndrome; Acute kidney failure; Adult; Alanine aminotransferase blood level; Anuria; Article; Aspartate aminotransferase blood level; Cardiogenic shock; Case report; Chronic kidney failure; Clinical article; Contrast induced nephropathy; Crackle; Creatine kinase blood level; Creatinine blood level; Dyslipidemia; Extended daily dialysis; Heart failure; Heart infarction; Heart left ventricle ejection fraction; Human; Ischemic heart disease; Lethargy; Low drug dose; Malaise; Male; Mean arterial pressure; Middle aged; Myalgia; Oliguria; Percutaneous coronary intervention; Peripheral edema; Physical examination; Potassium blood level; Pulse oximetry; Renal replacement therapy; Rhabdomyolysis; Transthoracic echocardiography
Subjects: R Medicine
R Medicine > R Medicine (General)
Divisions: Universiti Malaya Medical Centre (UMMC)
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 15 Nov 2023 01:22
Last Modified: 15 Nov 2023 01:22

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