Renal impairment rhabdomyolysis

Rhabdomyolysis is the destruction of skeletal muscle tissues and may be associated with lipid-regulating drugs such as the fibrates and the statins. The risk of this side-effect is increased in patients with renal impairment and with hypothyroidism. Rhabdomyolysis may also occur with nicotinic acid, the antipsychotic aripiprazole, and the anaesthetic propofol. 

WARNING Cases of fulminant liver failure resulting in death have occurred Uses Adjunct to carbidopa/levodopa in Parkinson Dz Action COMT inhibitor slows levodopa metabolism Dose 100 mg PO tid w/ 1st daily levodopa/carbidopa dose, then dose 6 12 h later -1- w/ renal impair Caution [C, ] Contra Hqjatic impair, w/ nonselective MAOI Disp Tabs SE Constipation, XCTOstomia, vivid dreams, hallucinations, anorexia, N/D, orthostasis, liver failure, Rhabdomyolysis Interactions T Effects OF CNS dqjressants, SSRIs, TCAs, warfarin, EtOH t risk of hypotensive crisis W/ nonselective MAOIs (phenelzine, tranylc5 promine) EMS Has been associated w/ liver failure and death may experience hallucinations concurrent EtOH use can T CNS dqjression T effects of warfarin severe D is common sevoal wks afto starting OD May cause NA and dizziness... 

Rhabdomyolysis with or without renal impairment has been reported in patients taking both erythromycin and lovastatin (14). The exact mechanism is unknown, but lovastatin is extensively metabolized by CYP3A4 and its metabolism may therefore be inhibited by erythromycin. The manufacturers have advised that careful monitoring is required when these two drugs are given together. 

The Committee on Safety of Medicines (CSM) has advised that rhabdomyolysis with lipid-regulating drugs is rare (1 case in every 100 000 treatment years) but may be increased in those with renal impairment and/or hypothyroidism. 

An 18-year-old man was found collapsed outside the nightclub. He had taken five ecstasy tablets and some powder that was later confirmed as ecstasy. He was vomiting and agitated, had a tachycardia and hyperthermia, and needed mechanical ventilation. He later developed rhabdomyolysis and renal impairment with raised liver enzymes. He went on to develop pneumonia and a urinary tract infection. He was discharged after 32 days with a mildly ataxic gait and dysphonia secondary to vocal cord damage. 

A 69-year-old woman, who had taken gliclazide 40 mg/ day for 3 months, was switched to glibenclamide 2.5 mg/ day. She had malaise for 2 days, followed by anorexia, fever, and 2 days later erythema mrrltiforme over her whole body. She also had Uver dysfrmction, renal impairment, and rhabdomyolysis. A lymphocjde stimulation test was positive for gUbenclamide, which was withdrawn the rash improved and the laboratory tests normalized within 4 days. 

Tricholoma equestre (Tricholoma flavovirens) "Yellow trich","shimokoshi", "man on horseback" or"yellow-knight fungus" None Unkown Repeated ingestion may lead to severe rhabdomyolysis and renal impairment [104]... 

A 68-year-old man who had been taking simvastatin 40 mg daily longterm without problem developed rhabdomyolysis (progressive muscle pain and weakness, tea-coloured urine, renal impairment, and a raised creatine phosphokinase) within 3 weeks of starting to take danazol 200 mg three times daily. He was given haemodialysis and subsequently recovered. 

Skeletal muscle effects The use of fibrates alone, including fenofibrate, may occasionally be associated with myopathy. Treatment with drugs of the fibrate class has been associated on rare occasions with rhabdomyolysis, usually in patients with impaired renal function. Consider myopathy in any patient with diffuse myalgias, muscle tenderness or weakness, or marked elevations of creatine phosphokinase levels. 

Uses Hypertriglyceridemia, coronary heart Dz Action Fibric acid Dose 1200 mg/d PO bid 30 min ac am pm Caution [C, ] t Warfarin effect, sulfony-lureas t risk of myopathy w/ HMG-CoA reductase inhibitors X effects w/ cyclosporine Contra Renal/hepatic impair (SCr >2.0 mg/dL), gallbladder Dz, primary biliary cirrhosis, use w/ repaglinide (i glucose) Disp Tabs 600 mg SE Cholelithiasis, GI upset Interactions t Effects OF anticoagulants, sulfonylureas t risk of rhabdomyolysis W/ HMG-CoA reductase inhibitors X effects W/ rifampin X effects OF cyclosporine EMS t Effects of anticoagulants OD May... 

Hohenberger P, Haier J, Schlag PM. Rhabdomyolysis and renal function impairment after isolated limb perfusion—comparison between the effects of perfusion with rhTNF alpha and a triple-drug regimen. Em J Cancer 199733(4) 596-601. 

Kotanko R Kirisits W, Skrabal F. Rhabdomyolysis and acute renal graft impairment in a patient treated with simvastatin, tacrolimus, and fusidic acid (letter). Nephron 2002 90 234-235. 

III. Clinical presentation. Within minutes to a few hours after ingestion, victims develop profound hypokalemia and skeletal muscle weakness progressing to flaccid paralysis of the limbs and respiratory muscles. Ventricular arrhythmias, hypophosphatemia, rhabdomyolysis, acute renal failure, and coagulopathy may also occur. Gastroenteritis with severe watery diarrhea, mydriasis with impaired visual accommodation, and CNS depression are sometimes present. More often, patients remain conscious even when severely Intoxicated. 

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