环孢素、来氟米特和瑞舒伐他汀药物相互作用致肾移植受者横纹肌溶解和急性肾损伤：错失药师参与机会。

Rhabdomyolysis and acute kidney injury potentiated by a drug-drug interaction between cyclosporine, leflunomide, and rosuvastatin in a kidney transplant recipient: A missed opportunity for pharmacist involvement.

出版信息

J Am Pharm Assoc (2003). 2024 May-Jun;64(3):102016. doi: 10.1016/j.japh.2024.01.012. Epub 2024 Jan 23.

DOI:10.1016/j.japh.2024.01.012

Abstract

BACKGROUND

This study aimed to describe a case of rhabdomyolysis and acute kidney injury potentiated by a drug-drug interaction (DDI) between cyclosporine, leflunomide, and rosuvastatin in a kidney transplant recipient.

CASE SUMMARY

A 74-year-old male with end-stage kidney disease secondary to type 2 diabetes mellitus and hypertension received a deceased by cardiac death kidney transplant. The patient's medical history included coronary artery disease and hyperlipidemia for which he was receiving rosuvastatin 40 mg daily. Five months after transplant, the patient developed BK viremia, which required multiple changes in immunosuppression and resulted in the initiation of leflunomide and cyclosporine modified. The patient used multiple pharmacies and coupon cards that delayed the identification of the DDIs between leflunomide, cyclosporine, and rosuvastatin. Approximately, 13 months after transplant, the biopsy report of the patient's allograft kidney showed acute cellular rejection Banff IB, hypertensive changes, and transplant glomerulopathy. This prompted the patient to receive a 3-day course of methylprednisolone 250 mg intravenous at the outpatient infusion center. Two weeks later, the patient presented to the transplant clinic with lightheadedness, dizziness, weakness, fatigue, bilateral eye drainage, and a decrease in appetite and was admitted to the hospital for further workup. On admission, creatine kinase was 2080 IU/L with myoglobin of 7601 ng/mL. The patient's diagnosis was statin myopathy with possible rhabdomyolysis acute kidney injury. Likely contributing factors included cyclosporine, leflunomide, and rosuvastatin DDI and administration of high-dose methylprednisolone.

PRACTICE IMPLICATIONS

This case demonstrates the importance of pharmacist involvement throughout all phases of care in a kidney transplant recipient.

摘要

背景

本研究旨在描述 1 例肾移植受者因环孢素、来氟米特和瑞舒伐他汀之间的药物相互作用（DDI）导致横纹肌溶解症和急性肾损伤。

病例总结

1 名 74 岁男性，因 2 型糖尿病和高血压继发终末期肾病，接受了脑死亡供体的肾移植。患者的病史包括冠心病和高脂血症，接受瑞舒伐他汀 40mg 每日治疗。移植后 5 个月，患者发生 BK 病毒血症，需要多次改变免疫抑制方案，导致开始使用来氟米特和环孢素。患者使用了多家药店和优惠券，这延迟了来氟米特、环孢素和瑞舒伐他汀之间 DDI 的识别。大约移植后 13 个月，患者移植肾活检报告显示急性细胞性排斥反应 Banff IB 级、高血压改变和移植肾小球病。这促使患者在门诊输注中心接受了 3 天的甲泼尼龙 250mg 静脉治疗。2 周后，患者因头晕、头晕、乏力、疲劳、双侧眼部分泌物、食欲下降而就诊于移植诊所，并住院进一步检查。入院时，肌酸激酶为 2080IU/L，肌红蛋白为 7601ng/ml。患者的诊断为他汀类肌病伴可能的横纹肌溶解症急性肾损伤。可能的促成因素包括环孢素、来氟米特和瑞舒伐他汀 DDI 以及大剂量甲泼尼龙的使用。