Banakh Iouri, Haji Kavi, Kung Ross, Gupta Sachin, Tiruvoipati Ravindranath
Department of Pharmacy, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia.
Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia.
Case Rep Crit Care. 2017;2017:3801819. doi: 10.1155/2017/3801819. Epub 2017 May 25.
Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness. A muscle biopsy was performed to exclude myositis which confirmed extensive myonecrosis, consistent with statin associated rhabdomyolysis. After a prolonged ventilatory course in the intensive care unit, patient's condition improved with recovery from renal and liver dysfunction. The patient slowly regained her upper and lower limb function; she was successfully weaned off the ventilator and was discharged for rehabilitation. To our knowledge, this is a second case of statin associated rhabdomyolysis due to interaction between atorvastatin and ticagrelor. However, our case differed in that the patient was also on amlodipine, which is considered to be a weak cytochrome P450 3A4 inhibitor and may have further potentiated myotoxicity.
阿托伐他汀与替格瑞洛联合用药是缺血性心脏病二级预防中被广泛接受的治疗方法。然而，横纹肌溶解是他汀类药物一种众所周知的罕见副作用，在与细胞色素P450 3A4酶抑制剂联合治疗时应予以考虑。我们报告一例阿托伐他汀与替格瑞洛相关的严重横纹肌溶解病例，该病例进展为多器官功能衰竭，需要进行肾脏替代治疗、使用血管活性药物、插管及机械通气。尽管停用了诱发原因并采取了包括肾脏替代治疗在内的支持措施，但由于横纹肌溶解持续进展导致上下肢无力，肌酸激酶仍升高。进行了肌肉活检以排除肌炎，结果证实存在广泛的肌坏死，符合他汀类药物相关的横纹肌溶解。在重症监护病房经过长时间的通气治疗后，患者病情好转，肾功能和肝功能恢复。患者逐渐恢复上下肢功能；成功脱机并出院进行康复治疗。据我们所知，这是第二例因阿托伐他汀与替格瑞洛相互作用导致的他汀类药物相关横纹肌溶解病例。然而，我们的病例不同之处在于患者还服用氨氯地平，氨氯地平被认为是一种弱细胞色素P450 3A4抑制剂，可能进一步增强了肌毒性。
