Reactions 1433 - 5 Jan 2013

SPregabalin/simvastatin

Rhabdomyolysis in an elderly patient: case reportA 70-year-old man developed rhabdomyolysis while

receiving pregabalin [Lyrica] and simvastatin [Zocor].The man presented to an emergency department with

generalised extremity weakness, mental disorientation andatonic legs. His right side and four extremities were twitching,and his speech was slurred. His medical history includedfibromyalgia, type 2 diabetes mellitus, peripheral neuropathy,hypercholesterolaemia and chronic low back pain. He hadbeen receiving oral pregabalin 50mg three times daily for anunknown duration, as well as lisinopril, amitriptyline,oxycodone and metformin. Four days earlier, his pregabalindose had been increased to 100mg three times daily, and hehad started receiving oral simvastatin 20mg daily. Laboratorytests revealed a significant elevation in creatine phosphokinaselevels (CPK) and serum creatinine levels (SCr). He wasdiagnosed with rhabdomyolysis, probably due to statintherapy, and was admitted.

Simvastatin was withdrawn, and the man received sodiumchloride, then sodium bicarbonate. On hospital day 2, CPKreached 14 191 units/L, and SCr peaked at 1.6 mg/dL. He alsodeveloped elevated liver enzymes. He had received one doseof pregabalin and lisinopril that morning, without simvastatin.That afternoon, pregabalin, lisinopril and metformin werewithdrawn. He received heparin, insulin and insulin glargine.The next day, his strength, balance and mental status hadimproved; CPK and SCr levels also began to decrease. Upondischarge, it was recommended that he restart lisinopril andmetformin; however, pregabalin and simvastatin were notrestarted.

Author comment: "We applied [the Naranjo] algorithm inour case. The causality rating for both pregabalin andsimvastatin fell within the range of 5 to 8, which indicates aprobable ADR."Kaufman MB, et al. Pregabalin and simvastatin: First report of a case ofrhabdomyolysis. P and T 37: 579-581&595, No. 10, Oct 2012 - USA 803081348

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Reactions 5 Jan 2013 No. 14330114-9954/10/1433-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved