ABSTRACT
A 64-year-old woman with ischemic heart disease was admitted to our hospital because of both leg pain and difficulty to walk for 5 days. She had taken cerivastatin and gemfibrozil for atherosclerosis and ischemic heart disease. One year ago, she had been admitted to our hospital because of acute renal failure due to rhabdomyolysis of unknown origin and was improved after conservative therapy. Laboratory studies revealed serum creatinine 1.2 mg/dL, creatine kinase 23,700 IU/L, serum myoglobin >500 ng/mL, urine myoglobin >3,000 ng/mL. (99m)Tc-HDP whole body Bone scan showed multiple increased uptakes of the soft tissue, especially both calf. With supportive care, she was recovered and discharged with normal creatinine(0.8 mg/dL) and creatine kinase(260 IU/L).
Subject(s)
Female , Humans , Middle Aged , Acute Kidney Injury , Atherosclerosis , Creatine , Creatine Kinase , Creatinine , Gemfibrozil , Leg , Myocardial Ischemia , Myoglobin , RhabdomyolysisABSTRACT
Most currently available statins are associated with an increase with risk of myositis, including rhabdomyolysis. Myopathy is believed to be caused by interference in the cytochrome P450 3A4 enzyme system, which results in a marked increase in reductase activity. Cerivastatin, a new synthetic HMG-CoA reductase inhibitor, is a safe, well-tolerated effective drug for the treatment of patients with dyslipidemia. The drug is metabolized by the cytochrome P450 3A4 and cytochrome P450 2C8 hepatic isoenzymes. Because of this dual metabolic pathway, it has been suggested that cerivastatin is less subject to drug-todrug interactions. We describe a 60-year-old woman with rhabdomyolysis and localized myositis, after she had taken cerivastatin(lipobay, 0.3 mg/day) and gemfibrozil(lopid, 500 mg/day) for 1month.
Subject(s)
Female , Humans , Middle Aged , Cytochrome P-450 Enzyme System , Dyslipidemias , Gemfibrozil , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Isoenzymes , Metabolic Networks and Pathways , Muscular Diseases , Myositis , Oxidoreductases , RhabdomyolysisABSTRACT
Cerivastatin is novel HMG-CoA reductase inhibitors. Clinical trials showed no significant differences of serum creatine kiase between cerivastatin and placebo, and cerivastatin-induced myopathy was rarely reported. This beneficial effect of cerivastatin is thought to be related to the the dual pathway metabolism by hapatic CYP3A4 and 2C8. We here report three cases of rhabdomyolysis which is associated with cerivastatin therapy. Two patients had diabetes mellitus, and received cerivastatin(0.8 mg/day) for treating hyperlipidemia and the other patient had chronic renal failure due to diabetic nephropathy and has maintained peritoneal dialysis and received cerivastatin(0.4 mg/day). Within one month of cerivastatin treatment, those patients experienced myalgia or muscle weakness. At that time, laboratory findings including muscle enzyme level, and bone scan finding were compatible with rhadomyolysis. Under the impression of cerivastatin- induced rhabodmyolysis, cerivastatin was withdrwan, and conventional treatment for rhabdomyolysis was started. Clinical course was uneventful, and these patients were discharged with good general condition. In conclusion, cerivastatin is regarded as a safe drug as compared with other statins, but it also causes rhabdomyolysis. Careful history taking and regular follow-up of muscle enzyme levels would be necessary to detect cerivastatin-induced rhabdomyolysis.
Subject(s)
Humans , Creatine , Diabetes Mellitus , Diabetic Nephropathies , Follow-Up Studies , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hyperlipidemias , Kidney Failure, Chronic , Metabolism , Muscle Weakness , Muscular Diseases , Myalgia , Peritoneal Dialysis , RhabdomyolysisABSTRACT
The side effects of cerivastatin on the skeletal muscle include muscle pain, muscle weakness accompanying with the increased creatinin - kinase rarely malignant hypermyoglobin uric leading the secondary renal failure. The Bayer pharmaceutical Company withdrawed all dosage form of cerivastatin in England and America in the 8th and 9th August 2001.
Subject(s)
Pyridines , Withholding TreatmentABSTRACT
BACKGROUND: Cerivastatin is a kind of statin, a synthetic HMG-CoA reductase inhibitor with high liver selectivity which lowers plasma cholesterol level by inhibiting endogenous cholesterol synthesis. This study evaluates the efficacy, safety, and tolerability of cerivastatin 0.1 mg and 0.3 mg in Korean patients with primary hypercholesterolemia. METHODS: A parallel group, randomized, placebo-controlled, double-blind study was conducted at Samsung Medical Center. The patients with primary hypercholesterolemia were placed on an American Heart Association Step 1 diet for whole study period. Single-blind placebo was administered for the final 4 weeks of period A, before randomization. Thirty two patients with low-density lipoprotein cholesterol (LDL-C) >160 mg/dL (if patients with a definite personal history of coronary heart disease (CHD) or with two or more cardiovascular risk factors, LDL-C >130 mg/dL) were randomized to 6 weeks treatment with one of the following regimens: cerivastatin 0.1 mg (n=11) or cerivastatin 0.3 mg (n=10) or placebo once daily at bedtime (n=11). RESULTS: Cerivastatin 0.1 mg and 0.3 mg treatment groups produced statistically significant (p<.05) changes at 6 weeks after treatment, compared to baseline and placebo in LDL-C (cerivastatin 0.1 mg 16.3%; cerivastatin 0.3 mg 35.2%; placebo 1.5%) and total cholesterol (cerivastatin 0.1 mg 10.3%; cerivastatin 0.3 mg 26.2%; placebo 1.3%). Cerivastatin 0.1 mg and 0.3 mg treatments were well tolerated and resulted in no significant increase in biochemical or clinical side effects compared to placebo. CONCLUSION: Cerivastatin at doses of 0.1 mg and 0.3 mg/day is a safe, well-tolerated, and highly effective HMG-CoA reductase inhibitor for the treatment of primary hypercholesterolemia.