Čes. slov. farm. 2020, 69(2):100-102 | DOI: 10.36290/csf.2020.015

Rosuvastatin-induced rhabdomyolysis due to medication errors

Martin Vodička^1,*, Ondřej Slanař², Michal Pisár¹, Tomáš Šálek¹

¹ The Tomas Bata Hospital in Zlín, Czech Republic

² Institute of Pharmacology, First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Prague, Czech Republic

Case (description): A 74 years old Caucasian suffering from chronic kidney disease presented with progressive asthenia and diffuse myalgia. It was revealed that the patient used three different rosuvastatin-containing preparations in a total daily dose of 120 mg for 76 days. Laboratory investigations revealed a marked elevation of serum urea, creatinine, myoglobin, creatine kinase (CK) and transaminases. Two serious medication errors have been identified as possible major factors that synergistically contributed to the development of rosuvastatin-induced rhabdomyolysis. First, 40 mg of rosuvastatin dose was prescribed to the patient, although the estimation of glomerular filtration rate (eGFR) declined below 
40 ml/min/1.73 m². Moreover, the patient used 3 different rosuvastatin formulations simultaneously in a total dose of 120 mg/day. The heterozygous CYP2C9*1/*3 genotype and warfarin co-administration could further contribute to the development of rhabdomyolysis. A number of preventive measures, notably in drug policy, are suggested to overcome unintended intoxications.

Conclusion: Rosuvastatin-induced myopathy is a rare, but serious adverse effect. This case report highlights the need for a proper treatment and dose adjustment during chronic medical therapy, the need for adequate patient education and application of adequate drug policy measures in the era of fragmented health care delivery and polypragmasia.

Keywords: rosuvastatin; adverse effects; medication errors; rhabdomyolysis

Grants and funding:

This paper has been supported by the Charles University project PRVOUK P25/LF1/2.

Received: January 27, 2020; Accepted: February 18, 2020; Published: February 1, 2020  Show citation