Infectious Diseases Service, Hospital Ramón y Cajal, Madrid, Spain.
Liver Transpl. 2011 Mar;17(3):331-3. doi: 10.1002/lt.22225.
Statins are relatively safe first-line agents to use in the setting of dyslipidemia associated with immunosuppressive therapy in subjects undergoing liver transplantation, and also in HIV-infected patients with dyslipidemia due to antiretroviral drugs, especially ritonavir-boosted protease inhibitors. Rosuvastatin, a new statin, has demonstrated higher potency than previously released statins and is not extensively metabolized by the liver P450 system; therefore, the probability of deleterious pharmacokinetic interactions with commonly used immunosuppressants and antiretroviral drugs is reduced. We present the first case of severe rhabdomyolysis in a liver transplant patient receiving rosuvastatin for the treatment of immunosuppressive therapy-related grade IV dyslipidemia, an HIV-infected subject on protease inhibitor-sparing HAART, that resolved after rosuvastatin withdrawal, probably related to interactions between calcineurin inhibitors and hepatic rosuvastatin uptake transporters such as organic anion transporting polypeptides (OATPs).
他汀类药物是肝移植患者免疫抑制治疗相关血脂异常和 HIV 感染患者抗逆转录病毒药物（尤其是利托那韦增强型蛋白酶抑制剂）相关血脂异常的一线治疗药物，相对安全。新型他汀类药物罗苏伐他汀比之前的他汀类药物具有更高的效力，且其在肝脏 P450 系统中不被广泛代谢；因此，与常用免疫抑制剂和抗逆转录病毒药物发生有害药代动力学相互作用的可能性降低。我们报道了首例肝移植患者应用罗苏伐他汀治疗免疫抑制治疗相关的 IV 级血脂异常时出现严重横纹肌溶解症的病例，该患者为 HIV 感染接受蛋白酶抑制剂节约型高效抗逆转录病毒治疗的患者，在停用罗苏伐他汀后缓解，可能与钙调神经磷酸酶抑制剂和肝脏罗苏伐他汀摄取转运体（如有机阴离子转运多肽）之间的相互作用有关。
