The incidence, risk factors, and clinical outcomes of rhabdomyolysis associated with fenoverine prescription: a retrospective study in South Korea (1999-2014).

BACKGROUND: Fenoverine is a spasmolytic drug that has been used to treat abdominal pain. Although sporadic case reports or case series of rhabdomyolysis associated with fenoverine have been published, there are no studies evaluating the incidence, risk factors, and clinical outcomes of rhabdomyolysis associated with fenoverine prescription. METHODS: We retrospectively reviewed the medical records of 22 patients admitted with rhabdomyolysis associated with fenoverine from January 1999 to December 2014, while excluding other well-known risk factors of rhabdomyolysis. This period was subdivided into two periods, January 1999-December 2007 and January 2008-December 2014. We analyzed the clinical and laboratory characteristics, and the prognosis of fenoverine associated with rhabdomyolysis for these times. RESULTS: The incidence of rhabdomyolysis associated with fenoverine was 0.27% during the total period (22/8257), 0.34% in the first period (18/5298), and 0.14% in the second period (4/2959) (p < 0.001). Rhabdomyolysis occurred in 19 liver cirrhosis (LC) patients (2.03%), whereas only 3 cases (0.04%) occurred in non-LC patients (p < 0.001). Drug duration, total dose, muscle enzymes, and clinical characteristics were not different between the LC and non-LC groups. Acute renal failure (ARF) occurred in 5 patients in the LC group and 2 patients in the non-LC group (p = 0.227). Severity of hepatic derangement according to the Child-Pugh classification was not different between the ARF group and non-ARF group (p = 0.227). Four patients died, having complications of oliguric ARF (p = 0.005) and underlying severe LC (p = 0.017). Higher serum lactate dehydrogenase, blood urea nitrogen, creatinine, and potassium levels but lower serum sodium levels were found in the group that died (p = 0.001). CONCLUSIONS: Physicians should carefully prescribe fenoverine because it may cause rhabdomyolysis, especially in patients with LC.

A case of bilateral leg edema associated with levofloxacin: A case report.

RATIONALE: A number of medicines are associated with edema. However, only 2 cases of edema of both lower legs, associated with levofloxacin, have been reported. PATIENT: We report the case of levofloxacin-associated bilateral leg edema in an 81-year-old male. The patient was referred to the Division of Nephrology due to edema limited to both lower legs, which had developed 1 day before. He had undergone supraglottic laryngectomy due to supraglottic cancer in our institution 6 months ago. He had been admitted to the Department of Otolaryngology due to persistent aspiration and general weakness 5 days ago. DIAGNOSIS: The patient had no underlying diseases that could result in edema. No abnormalities were detected in several diagnostic tests. He strongly denied using other medications including herbal or traditional remedies, recreational drugs, or drugs of abuse. The patient had been intravenously administered levofloxacin at 750 mg per day 5 days earlier; on this basis levofloxacin-induced edema was suspected. INTERVENTIONS AND OUTCOMES: Levofloxacin was immediately withdrawn and conservative management (salt restriction and withdrawal of intravenous fluid) was initiated. His edema was completely restored within 3 weeks after withdrawal of levofloxacin. OUTCOMES: The patient stopped taking levofloxacin and he did not have any recurrent edema until his death due to uncontrolled pneumonia. LESSONS: Levofloxacin should be added to the list of drugs associated with the development of bilateral leg edema. This might obviate the need for time-consuming studies for diagnostic purposes and application of ineffective or harmful treatments.