Rhabdomyolysis After Concomitant Use of Simvastatin and Voriconazole in an Allogeneic Stem Cell Transplant Patient

Rita M Cool, Alison M Gulbis

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Objective: To report a case of rhabdomyolysis after concomitant use of simvastatin and voriconazole.

Case Summary: A 65-year-old white male, weight 66 kg, 79 months post allogeneic stem cell transplant for chronic lymphocytic leukemia, was on a stable medication regimen that included voriconazole. He was hospitalized with weakness and elevated creatine kinase a few weeks after initiation of simvastatin for treatment of hyperlipidemia. His symptoms resolved and creatine kinase level returned to within the normal range after fluid administration and discontinuation of simvastatin.

Discussion: A 65-year-old white male, weight 66 kg, 79 months post allogeneic stem cell transplant for chronic lymphocytic leukemia, was on a stable medication regimen that included voriconazole. He was hospitalized with weakness and elevated creatine kinase a few weeks after initiation of simvastatin for treatment of hyperlipidemia. His symptoms resolved and creatine kinase level returned to within the normal range after fluid administration and discontinuation of simvastatin.

CONCLUSIONS: Due to the broad use of statins for the treatment and prevention of atherosclerotic disease, as well as the need for azole antifungals in the stem cell transplant population, interactions between these agents are becoming an increasing possibility. Care should be taken to minimize these interactions and, when feasible, a change to an alternative agent may be warranted to avoid adverse effects.

J Pharm Technol 2013;29:135-8