SHM Converge Scientific Abstract ePoster Gallery-The Weakness of Rashly Prescribing of Medications

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This case describes a 97-year-old man with hypertension, COPD, CAD, diabetes, prior CVA, and hyperlipidemia who presented with one week of generalized weakness, proximal bilateral leg weakness, and muscle soreness. Ten days earlier, he had completed a 10-day course of fluconazole for groin candidiasis while continuing simvastatin. Exam showed marked proximal lower-extremity weakness and thigh/calf tenderness. Initial imaging was unrevealing, but labs showed markedly elevated CK (5988), mild kidney injury, elevated AST/ALT, and urine positive for blood without RBCs, consistent with rhabdomyolysis.<br /><br />The team suspected a drug-drug interaction: fluconazole, a potent CYP3A4 inhibitor, increased simvastatin levels and triggered acute statin-induced rhabdomyolysis. Both medications were stopped, the patient received IV hydration, and his symptoms improved rapidly with CK normalization over 10 days. His fungal rash was treated with nystatin. He returned to baseline ambulation and was discharged with instructions to follow up and consider switching to rosuvastatin.<br /><br />The discussion emphasizes that statins are commonly used for cardiovascular prevention and are generally well tolerated, but CYP3A4-inhibiting medications such as azole antifungals, macrolides, some calcium channel blockers, protease inhibitors, and cyclosporine can significantly raise statin concentrations and increase the risk of rhabdomyolysis. Simvastatin is particularly susceptible. A practical prevention strategy is to temporarily stop statins 2 days before and after short courses of interacting medications.<br /><br />The key clinical lesson is the importance of careful medication review and reconciliation, even with common prescriptions, to prevent serious but avoidable adverse drug interactions.

Asset Subtitle

Risheng Xu

Meta Tag

Author List Joslyn Fisher, Risheng Xu, Shazia Sheikh, Ya Li

Category Clinical Vignettes

Concept Statin

Concept Rhabdomyolysis

Concept CYP3A4

Concept CYP3A4 Inhibitor

Concept Fluconazole

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Risheng Xu

Track Adult

Keywords

rhabdomyolysis

simvastatin

fluconazole

drug-drug interaction

CYP3A4 inhibition

statin toxicity

muscle weakness

elevated creatine kinase

azole antifungal

medication reconciliation

Statin

Rhabdomyolysis

CYP3A4

CYP3A4 Inhibitor

Fluconazole