Rhabdomyolysis and acute renal failure associated with pravastatin and simvastatin

Statins are competitive inhibitors of hydroxy-methyl-glutaryl coenzyme A (H MG-CoA) reductase and are the most commonly used drugs to treat hyperlipida emia. Muscle toxicity is an adverse effect reported with a low incidence an d rarely associated with acute renal failure due to rhabdomyolysis. We desc ribe two patients with chronic renal failure treated with pravastatin and s imvastatin who suffered rhabdomyolysis and acute renal failure. One patient started pravastatin several days after cessation of bezafibrate and develo ped acute renal failure without needing dialysis. The other was treated wit h simvastatin three years ago and suffered rhabdomyolysis when renal functi on was impaired after indomethacin was prescribed for backache. He needed h emodialysis because of acute cardiac failure and died from a respiratory in fection while on mechanical ventilation. Myopathy was reversible in both pa tients. We recommend starting statins with the lower doses in chronic renal failure and monitoring muscle enzymes when renal function changes or when new drugs with potential interactions are prescribed.