RHABDOMYOLYSIS WITH CONCURRENT ATROVASTATIN AND SITAGLIPTIN IN THE SETTING OF VITAMIN D DEFICIENCY

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چکیده

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The role of statin metabolism and Vitamin D have been established even associated with induced myopathy. This case suggests a plausible link between myopathy the use sitagliptin concurrently atorvastatin, in patient low vitamin D. We highlight crucial interaction cytochrome P450 that may contribute to toxicity. CASE PRESENTATION: A 69-year-old man past medical history CAD status post PCI (1 year ago), diabetes mellites type 2, hypertension, dyslipidemia presented 2-month progressive fatigue, dyspnea on exertion, muscle weakness upper lower extremities. He was started 25 mg Qday 8 months ago had atorvastatin 80mg Qday. ECG echocardiogram were without acute changes. Pertinent labs AST/ALT 210/254, moderate blood UA RBCs, CPK 9923, TSH 2.31, ESR 20, CRP 14.9, level 12, B12 127. IV fluids, held, supplementation started. Methylprednisolone later added regimen after biopsy. Muscle biopsy showed scattered basophilic regenerating fibers very few necrotic consistent toxic related immune-mediated necrotizing HMG Coenzyme reductase antibody test resulted positive, which can be autoimmune DISCUSSION: is responsible for upregulating transcription enzyme called CYP3A4 gastrointestinal mucosa liver. Atorvastatin, metabolized by liver, substrate CYP3A4. Interaction/inhibition known cause increase seen Sitagliptin part In vivo, alone no inhibitory effect However, several reports rhabdomyolysis patients using sitagliptin. based possible competitive turn decreases metabolism. CONCLUSIONS: Our patient's deficiency could collaborative leading levels available as inhibitor all together limit number active sites. lead increased thus higher chance As DPP4 inhibitors grow popularity given positive cardiac profile, it would monitor drug interactions statins same metabolic enzymes choose agents appropriately. It also worthwhile more vigilant screen levels. REFERENCE #1: Khan, M. W., Kurian, S., & Bishnoi, R. (2016). Acute-onset secondary interaction. International journal general medicine, 9, 103–106. https://doi.org/10.2147/IJGM.S98543 #2: Buttar, Batra, J., Kreimerman, Aleta, M., Melamed, L. (2017). Rhabdomyolysis AKI Atorvastatin Use Setting Low 25-Hydroxyvitamin Levels. Journal internal 32(10), 1156–1159. https://doi.org/10.1007/s11606-017-4115-x #3: Wang, Z., Schuetz, E. G., Xu, Y., Thummel, K. (2013). Interplay metabolizing steroid biochemistry molecular biology, 136, 54–58. https://doi.org/10.1016/j.jsbmb.2012.09.012 DISCLOSURES: No relevant relationships Ali Bokhari, source=Web Response Raza Hussain, Syed Sadiq,

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ژورنال

عنوان ژورنال: Chest

سال: 2021

ISSN: ['0012-3692', '1931-3543']

DOI: https://doi.org/10.1016/j.chest.2021.07.227