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

Author:

Siew Kelvin Shenq Woei1ORCID,Abdul Hafidz Muhammad Imran1ORCID,Mohd Zaidan Fatimah Zahrah Binti2,Hadi Mohd Firdaus bin1ORCID

Affiliation:

1. Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100 Kuala Lumpur, Malaysia

2. Department of Primary Care Medicine, University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100 Kuala Lumpur, Malaysia

Abstract

Abstract 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.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

Reference23 articles.

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