Statin and NSAID drugs lead to the death of a patient from kidney damage and severe skin lesions

This paper was published in the Annals of Saudi Medicine 2012 May-Jun;32(3):309-11

 

Study title and authors:

A fatal case of cutaneous adverse drug-induced toxic epidermal necrolysis associated with severe rhabdomyolysis.

Noordally SO, Sohawon S, Vanderhulst J, Duttmann R, Corazza F, Devriendt J.

Department of Critical Care Medicine, Centre Hospitalier Universitaire de Tubize-Nivelles, 1400 Nivelles, Belgium. Sheikoaleed.Noordally@chu-brugmann.be

 

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/22588445

 
Toxic epidermal necrolysis is a life-threatening skin condition that is usually induced by a reaction to medications. Atorvastatin is a recognized cause of rhabdomyolysis (the breakdown of muscle fibers that leads to kidney damage). Naproxen is a widely used nonsteroidal anti-inflammatory (NSAID) drug that is a known cause of skin lesions.
 
This paper reports of a fatal case of drug-induced toxic epidermal necrolysis associated with severe muscle necrosis (death of muscle cells) due to the use of Naproxen and a statin.
 
(i) A 61-year-old female patient was admitted to hospital with complaints of breathing difficulties, vomiting, and diarrhea that started two days prior to admission.
(ii) Her medications included atorvastatin 10 mg once daily and naxproxen 500 mg three times a day. 
(iii) Acute kidney injury and rhabdomyolysis were present on admission to the hospital.
(iv) She had very high levels of creatine phosphokinase (indicating muscle damage by statins).
(v) Naproxen treatment had started ten days before admission and had led to the rapid onset of skin lesions.
(vi) The patient rapidly developed multiple organ failure with respiratory failure, and complete skin necrosis (death of skin tissue). Despite treatment she died the following day.

The paper concludes that the patient died of drug induced toxic epidermal necrolysis associated with severe muscle necrosis due to the use of naproxen and statin drugs leading to acute kidney damage and complete skin necrosis.

Rhabdomyolysis induced by statins

This paper was published in Clinical Chemistry 1990 Dec;36(12):2145-7

Study title and authors:
Rhabdomyolysis secondary to lovastatin therapy.

Manoukian AA, Bhagavan NV, Hayashi T, Nestor TA, Rios C, Scottolini AG.
Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu 96822.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/2253372

This paper reports a case of lovastatin (Mevacor)-induced rhabdomyolysis (severe muscle breakdown which may lead to kidney damage).

(i) A 59 year old woman was admitted to hospital with a two day history of shortness of breath and difficulty walking. She had been discharged from hospital two weeks earlier for congestive heart failure and, since discharge, had experienced progressive weight gain and swelling of the feet and ankles such that walking had become difficult.
(ii) For 13 days before admission to hospital she had been taking lovastatin, 20 mg orally twice a day.
(iii) On the second hospital day she complained of profound muscle weakness in her lower extremities which progressed over several hours to include the upper extremities. In addition she could no longer walk because of severe pain.
(iv) Creatine kinase levels increased from 157 U/L two weeks before admission to 176,500 U/L on the twelfth hospital day. (High creatine kinase levels are a marker for rhabdomyolysis).
(v) The patient's symptoms and creatine kinase levels resolved after discontinuation of the statin drug.

As well as inhibiting the body from producing cholesterol, statins also repress the production of several other biologically essential compounds such as coenzyme Q10 and heme A which are important components in the system of mitochondrial energy production.

Mitochondria are known as the powerhouses of the cell. They are tiny cellular organelles that take in nutrients, break them down, and create energy for the cells.

Dr Manoukian speculates that the rhabdomyolysis was due to statin-induced mitochondrial damage secondary to inadequate synthesis of coenzyme Q10 and heme A.

Analysis of 119 statin randomized controlled trials find that statins increase the risk of muscle problems

This study was published in Pharmacoepidemiology and Drug Safety 2007 Feb;16(2):132-43

 

Study title and authors:

Systematic review and meta-analysis of clinically relevant adverse events from HMG CoA reductase inhibitor trials worldwide from 1982 to present.

McClure DL, Valuck RJ, Glanz M, Hokanson JE.

Kaiser Foundation Health Plan of Colorado, Clinical Research Unit, Denver, CO 80237-8066, USA. david.l.mcclure@kp.org

 

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/17072896

The objective of the study was to determine the association of adverse events from a systematic review and meta-analysis of statin randomized controlled trials. The study included over 86,000 participants from 119 studies.

The study found:
(a) Statin users had a 59% increased risk of rhabdomyolysis (the breakdown of muscle fibers that leads to the release of muscle fiber contents into the bloodstream and often causes kidney damage) compared to nonusers.
(b) Statin users had a 156% increased risk of myositis (inflammation of the muscles) compared to nonusers.
(c) Statin users had a 9% increased risk of myalgia (muscle pain) compared to nonusers.

This analysis of 119 statin randomized controlled trials found that statins increased the risk of muscle problems.