LOVASTATIN-INDUCED RHABDOMYOLYSIS POSSIBLY ASSOCIATED WITH CLARITHROMYCIN AND AZITHROMYCIN

OBJECTIVE: To describe two cases of rhabdomyolysis in patients taking lovastatin that were precipitated by the use of the newer macrolide an tibiotics clarithromycin and azithromycin. CASE SUMMARIES: In each cas e, the patients were treated over 5 years with lovastatin and develope d rhabdomyolysis that coincided with the completion of a prescribed re gimen of a newer macrolide antibiotic. Following intravenous hydration and administration of bicarbonate, the patients' condition resolved w ithout permanent sequelae. DISCUSSION: Rhabdomyolysis is a clinical sy ndrome resulting from the destruction of skeletal muscle that may prog ress to renal failure. Several drugs have been associated with rhabdom yolysis, including lovastatin, a hydroxymethylglutaryl-coenzyme A redu ctase inhibitor. Erythromycin is a macrolide antibiotic that may incre ase the risk of lovastatin-induced rhabdomyolysis. To our knowledge, t hese cases are the first published reports of lovastatin-induced rhabd omyolysis associated with azithromycin and clarithromycin. CONCLUSIONS : The risk of drug-induced rhabdomyolysis due to the potential interac tion between lovastatin and azithromycin or clarithromycin should be c onsidered before the concomitant use of these agents.