单药治疗依折麦布引起的横纹肌溶解症

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

治疗领域药物治疗病例介绍一位 62 岁的女性患者,既往病史为一型糖尿病、冠心病、高脂血症,曾因他汀类药物诱发横纹肌溶解症而出现一个月的肌肉疼痛加重。两个月前,她开始每天服用单药依折麦布 10 毫克。就诊时,化验结果显示肌酸激酶为2509 U/L(正常值:51-296 U/L)(图1),肌酐为1.5 mg/dL,基线为0.9 mg/dL(正常值为0.6-1.0 mg/dL),尿检显示肌红蛋白尿。开始静脉输液和服用止痛药物。鉴于自身免疫检查和甲状腺化验结果正常,且无其他诱发事件,因此决定停用依折麦布。肌酸激酶在停药 3 天内趋于正常水平,为 186 U/L(图 1)。她的肌痛有所改善,并开始在门诊接受蛋白转换酶枯草酶/kexin 9 型(PCSK9)抑制剂治疗。我们报告了一例罕见的单药依折麦布诱发横纹肌溶解症病例,患者既往曾因他汀类药物导致横纹肌溶解症。然而,在鉴别出现肌病或横纹肌溶解症的患者时,也应考虑单药依折麦布。需要对曾因他汀类药物引起肌病的患者进行更多研究,以确定他们使用依折麦布的风险是否也会增加。对于这些患者,应考虑将 PCSK9 抑制剂作为替代治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MONOTHERAPY EZETIMIBE-INDUCED RHABDOMYOLYSIS

Therapeutic Area

Pharmacologic Therapy

Case Presentation

A 62-year-old female with a past medical history of type one diabetes, coronary artery disease, hyperlipidemia, and previous statin-induced rhabdomyolysis presented with one month of worsening muscle pain. Two months ago, she was started on monotherapy ezetimibe 10mg daily. On presentation, labs were notable for creatine kinase of 2509 U/L (normal: 51-296 U/L) (figure 1), creatinine of 1.5 mg/dL with baseline 0.9 mg/dL (normal 0.6-1.0 mg/dL), and urinalysis with myoglobinuria. IV fluids and pain medications were started. Given normal autoimmune panel and thyroid labs with no other precipitating events, the decision was made to discontinue ezetimibe. Creatine kinase trended to normal levels of 186 U/L (figure 1) within 3 days of discontinuation. Her myalgias improved and she was started on a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor outpatient.

Background

Ezetimibe is often used in the setting of statin-induced myopathy. We report a rare case of monotherapy ezetimibe-induced rhabdomyolysis in a patient with previous history of rhabdomyolysis due to statins.

Conclusions

Previous cases in literature have reported combined ezetimibe/statin induced myopathy or rhabdomyolysis. However, monotherapy ezetimibe should also be considered in the differential for patients presenting with myopathy or rhabdomyolysis. More research needs to be performed in patients with previous myopathy due to statins to elucidate if they are at increased risk with ezetimibe as well. In these patients, PCSK9 inhibitors should be considered as an alternative treatment option.
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
6.60
自引率
0.00%
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审稿时长
76 days
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