International Journal of Clinical Pharmacy

, Volume 34, Issue 6, pp 825–827 | Cite as

Atorvastatin-related rhabdomyolysis and acute renal failure in a genetically predisposed patient with potential drug–drug interaction

  • Srecko MarusicEmail author
  • Ante Lisicic
  • Ivica Horvatic
  • Vesna Bacic-Vrca
  • Nada Bozina
Case Report


Case description A 75-year-old man developed rhabdomyolysis and acute renal failure during atorvastatin therapy. All medications were discontinued and the patient was treated with intermittent hemodialysis throughout the course of hospitalization. After four weeks, patient's kidney function tests and serum myoglobin levels decreased to normal values and muscle weakness gradually disappeared. Genotyping results showed that the patient had a single-nucleotide polymorphism within genes encoding the organic anion-transporting polypeptide 1B1 and ATP binding cassette sub-family B member 1, which predisposed him for statin-induced myopathy. He was also a poor metabolizer of cytochrome P450 2C19. Concomitant therapy with pantoprazole could have resulted in the inhibition of cytochrome P450 3A4-mediated metabolism of atorvastatin and contributed to the development of rhabdomyolysis. Conclusion The case illustrates the clinical relevance and relationship between pharmacogenetic and pharmacokinetic factors in the development of statin-induced myopathy.


Acute renal failure Adverse drug reaction Atorvastatin Drug-drug interaction Rhabdomyolysis 



We thank the employees of the Clinical Institute for Laboratory Diagnosis for their contribution to the manuscript.



Conflicts of interest

None of the authors of this manuscript had any conflict of interests connected with the conduct of the study.


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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Srecko Marusic
    • 1
    Email author
  • Ante Lisicic
    • 1
  • Ivica Horvatic
    • 2
  • Vesna Bacic-Vrca
    • 3
  • Nada Bozina
    • 4
  1. 1.Department of Clinical PharmacologyUniversity Hospital DubravaZagrebCroatia
  2. 2.Department of NephrologyUniversity Hospital DubravaZagrebCroatia
  3. 3.Department of Clinical PharmacyUniversity Hospital DubravaZagrebCroatia
  4. 4.Clinical Institute of Laboratory DiagnosisUniversity Hospital Center ZagrebZagrebCroatia

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