Statin-associated rhabdomyolysis triggered by drug-drug interaction with itraconazole.
Statin-associated rhabdomyolysis triggered by drug-drug interaction with itraconazole.
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DOI：
10.1136/bcr-2016-216457
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发表时间：
2016-09-07
期刊：
影响因子：
0.9
通讯作者：
Hellfritzsch, Maja
中科院分区：
文献类型：
--
作者：
Dybro, Anne Mette;Damkier, Per;Hellfritzsch, Maja
一名 47 岁女性多年来一直接受大剂量辛伐他汀治疗。使用抗真菌药物伊曲康唑进行全身治疗后，她出现肌肉疼痛，肌酸激酶和肌红蛋白水平高度升高。肌肉活检与他汀类药物相关的横纹肌溶解症相一致，这可能是由辛伐他汀和伊曲康唑之间的药物相互作用引起的。病人完全康复了。三种常用的他汀类药物——辛伐他汀、阿托伐他汀和洛伐他汀——由肝酶 CYP3A4 代谢。已知该酶的几种有效抑制剂，例如唑类抗真菌剂，如伊曲康唑和泊沙康唑。如果使用 CYP3A4 代谢的他汀类药物的患者需要抗真菌治疗，我们建议 (1) 如果可能，局部施用抗真菌药物，(2) 使用非 CYP3A4 抑制性抗真菌药物，如特比萘芬，或 (3) 暂时停止他汀类药物治疗。
A 47-year-old woman had been treated with high-dose simvastatin for several years. After systemic treatment with the antifungal agent itraconazole, she developed muscle pain and highly elevated levels of creatine kinase and myoglobin. Muscle biopsy was compatible with statin-associated rhabdomyolysis, probably caused by a drug-drug interaction between simvastatin and itraconazole. The patient made full recovery. Three commonly used statins-simvastatin, atorvastatin and lovastatin-are metabolised by the liver enzyme CYP3A4. Several potent inhibitors of this enzyme are known, for example, azole antifungal agents such as itraconazole and posaconazole. If antifungal treatment is indicated in a patient using a CYP3A4-metabolised statin, we recommend (1) topical administration of the antifungal agent if possible, (2) the use of a non-CYP3A4-inhibiting antifungal drug such as terbinafine or (3) temporary discontinuation of statin treatment.