ritonavir and Rhabdomyolysis

The presence of rhabdomyolysis secondary to multiple infections has been reported, predominantly viral, but also bacterial and fungal. It is well known that COVID-19 can present a wide variety of complications during the course of infection; however, the presence of rhabdomyolysis as an initial condition has not been reported so far. We report a case of rhabdomyolysis as an initial presentation in a patient diagnosed with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Anticoagulants; Azithromycin; Betacoronavirus; Bicarbonates; Ceftriaxone; Coronavirus Infections; COVID-19; Cytochrome P-450 CYP3A Inhibitors; Enoxaparin; Enzyme Inhibitors; Fluid Therapy; Humans; Hydroxychloroquine; Lopinavir; Lung; Male; Pandemics; Pneumonia, Viral; Respiration, Artificial; Rhabdomyolysis; Ritonavir; SARS-CoV-2; Tomography, X-Ray Computed; Treatment Outcome

Drugs like statins may induce rhabdomyolysis. Simvastatin and lovastatin have a high hepatic metabolism and their potential toxicity could be increased by interactions with other drugs that reduce their metabolism.. A case-report is presented of an HIV-infected patient treated with antiretroviral drugs who developed a rhabdomyolysis-induced renal failure and liver toxicity when simvastatin was substituted for atorvastatin. A literature review is also presented.. The patient required hospital admission and showed a favorable response after hydration and urine alkalinization. There were 4 additional cases published of which there was one death.. Drug-drug interactions can increase the risk of statin induced rhabdomyolysis. In order to evaluate them properly, physicians at all levels of clinical care should be aware of all drugs prescribed to their patients and the contraindicated combinations.

Topics: Antiretroviral Therapy, Highly Active; Atorvastatin; Chemical and Drug Induced Liver Injury; Comorbidity; Contraindications; Cost-Benefit Analysis; Cytochrome P-450 CYP3A Inhibitors; Drug Substitution; Drug Synergism; Dyslipidemias; Female; HIV Infections; HIV Protease Inhibitors; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Kidney Tubular Necrosis, Acute; Middle Aged; Rhabdomyolysis; Ritonavir; Simvastatin

The authors describe an HIV-infected patient with moderate renal failure receiving combination antiretroviral therapy. Because of dyslipidaemia he was initially treated with pravastatin but developed rhabdomyolysis after a switch to rosuvastatin. With this case we illustrate that statins as well as antiretroviral therapy are susceptible to clinical relevant drug-drug or drug-disease interactions. Knowledge of these interactions is important to provide patients with the best possible care.

Topics: Anti-HIV Agents; Drug Therapy, Combination; Dyslipidemias; Fluorobenzenes; HIV Infections; HIV-1; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lopinavir; Male; Middle Aged; Pyrimidines; Pyrimidinones; Renal Insufficiency; Rhabdomyolysis; Ritonavir; Rosuvastatin Calcium; Sulfonamides; Treatment Outcome

Protease inhibitors (PIs) inhibit the cytochrome P450 CYP3A4. Because the metabolism of pravastatin is independent of the cytochrome P450 CYP3A4, this drug has become the preferred statin for treatment of dyslipidemia associated with human immunodeficiency virus (HIV) infection, with no cases of serious toxicity such as rhabdomyolysis reported to date. We report an HIV-infected patient receiving antiretroviral regimen consisting of atazanavir, ritonavir, emtricitabine and tenofovir who developed severe rhabdomyolysis approximately 4 months after increasing his pravastatin dose from 40 to 80 mg daily. His symptoms resolved within 10 days after the discontinuation of pravastatin and antiretroviral therapy. To our knowledge, this is the first case of rhabdomyolysis possibly caused by pravastatin in an HIV-infected patient.

Topics: Adenine; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Atazanavir Sulfate; Deoxycytidine; Dyslipidemias; Emtricitabine; HIV Infections; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Oligopeptides; Organophosphonates; Pravastatin; Pyridines; Rhabdomyolysis; Ritonavir; Tenofovir

A case report of drug-induced rhabdomyolysis in a 34-year-old HIV-infected male with a history of liver disease and concomitant use of clarithromycin, atorvastatin, and lopinavir/ritonavir is presented.

Topics: Adult; Anti-Bacterial Agents; Atorvastatin; Clarithromycin; Drug Interactions; Drug Therapy, Combination; Heptanoic Acids; HIV Infections; HIV Protease Inhibitors; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Lopinavir; Male; Pyrimidinones; Pyrroles; Rhabdomyolysis; Ritonavir

Straightforward reports of unusual drug experiences are included in this section. While selected references may be cited, the purpose of a Drug Experience report is not to present an extensive review of the literature. A related section, Grand Rounds; includes papers that are well-documented patient case reports with a thorough review of the important literature to help put the case in perspective. Authors should report serious adverse drug reactions to the FDA medical products reporting program (MedWatch). Such reporting will not jeopardize the chances that AJHP will publish manuscripts on the same drug reactions.

Topics: Anti-HIV Agents; Anticholesteremic Agents; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme Inhibitors; Drug Interactions; Female; Humans; Middle Aged; Mixed Function Oxygenases; Rhabdomyolysis; Ritonavir; Simvastatin

Topics: Acquired Immunodeficiency Syndrome; Acute Kidney Injury; Adult; Alcoholism; Chemical and Drug Induced Liver Injury; Hepatitis C, Chronic; HIV Protease Inhibitors; Humans; Indinavir; Male; Rhabdomyolysis; Ritonavir