Pregabalin/simvastatin
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Reactions 1433 - 5 Jan 2013 S Pregabalin/simvastatin Rhabdomyolysis in an elderly patient: case report A 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 and atonic legs. His right side and four extremities were twitching, and his speech was slurred. His medical history included fibromyalgia, type 2 diabetes mellitus, peripheral neuropathy, hypercholesterolaemia and chronic low back pain. He had been receiving oral pregabalin 50mg three times daily for an unknown duration, as well as lisinopril, amitriptyline, oxycodone and metformin. Four days earlier, his pregabalin dose had been increased to 100mg three times daily, and he had started receiving oral simvastatin 20mg daily. Laboratory tests revealed a significant elevation in creatine phosphokinase levels (CPK) and serum creatinine levels (SCr). He was diagnosed with rhabdomyolysis, probably due to statin therapy, and was admitted. Simvastatin was withdrawn, and the man received sodium chloride, then sodium bicarbonate. On hospital day 2, CPK reached 14 191 units/L, and SCr peaked at 1.6 mg/dL. He also developed elevated liver enzymes. He had received one dose of pregabalin and lisinopril that morning, without simvastatin. That afternoon, pregabalin, lisinopril and metformin were withdrawn. He received heparin, insulin and insulin glargine. The next day, his strength, balance and mental status had improved; CPK and SCr levels also began to decrease. Upon discharge, it was recommended that he restart lisinopril and metformin; however, pregabalin and simvastatin were not restarted. Author comment: "We applied [the Naranjo] algorithm in our case. The causality rating for both pregabalin and simvastatin fell within the range of 5 to 8, which indicates a probable ADR." Kaufman MB, et al. Pregabalin and simvastatin: First report of a case of rhabdomyolysis. P and T 37: 579-581&595, No. 10, Oct 2012 - USA 803081348 1 Reactions 5 Jan 2013 No. 1433 0114-9954/10/1433-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Pregabalin/simvastatin
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
