Content Sources:
[1] Wu Jiayun, Li Xiao'e.Atorvastatin calcium-induced body pain: 1 case and literature review[J].China Health Care,2024,42(07):180-183.
[2] Zhang Zhengjuan, Pan Bo atorvastatin combined with bispecific antibody in the treatment of transient ischemic attack[J].Clinical Rational Medication,2024,17(11):59-62.DOI:10.15887/j.cnki.13-1389/r.2024.11.016.
[3] Wu Wenzhen, Wang Yiting.Clinical value of atorvastatin in emergency treatment of myocardial infarction[J].China Urban and Rural Enterprise Health,2024,39(02):119-121.DOI:10.16286/j.1003-5052.2024.02.044.
Atorvastatin is the third generation statin, and it is also the most powerful statin at present, it can play a relatively strong lipid-lowering effect in a smaller dose, and many patients with cardiovascular disease often need to take atorvastatin for a long time or even for life after the onset or surgery. But atorvastatin, when used incorrectly, can lead to a very serious condition that could eventually lead to the amputation of both legs!
59-year-old Uncle Wu is a fisherman, still in good health in his sixtieth year, but he had to say goodbye to the sea. This is all due to the uncontrolled drinking of beer when he was young, coupled with eating too much seafood that is high in purines. The weather at sea is unpredictable, and every time the wind blows, Uncle Wu's knees and toes hurt terribly, and he can't care about the work at hand.
After Uncle Wu, who retired early and stayed at home, left the sea where he had dealt with him for most of his life, he ate, sleeped, and slept every day without doing anything and did not go out for a walk. After a physical examination, I really had hyperlipidemia, and I needed to listen to the doctor's words to take atorvastatin to regulate blood lipids, otherwise it may lead to plaque formation and cause myocardial infarction and cerebral infarction.
In June 2018, Uncle Wu always felt that the muscles of his thighs were particularly sore recently, and even if he was just sitting, he felt a feeling of soreness and numbness, and it didn't work to rub it with his hands or cover it with a hot water bottle. I thought it was just a moment of fatigue when I was older, and it would soon disappear over time, but after a month, this soreness not only did not disappear, but also spread to my waist.
On July 7th, Uncle Wu was sitting on the sofa watching TV, and suddenly a burst of urine came up, but the soreness in his legs made him not want to move, and he couldn't hold it for a while before he slowly moved to the toilet, but the urine that came out scared Uncle Wu. Although it was diluted by the water in the toilet, you can still see that the color of the urine is no different from soy sauce!
This frightened Uncle Wu to the core, and the hand lifting his pants was fixed there. After reacting, he called his son's name in the toilet and asked him to rush him to the hospital. After listening to Uncle Wu's description, the emergency doctor hurriedly prescribed a urine routine, renal function test and creatine kinase level measurement for Uncle Wu.
Myoglobin was seen under urinalysis, and renal function showed aspartate aminotransferase 869 U/L and alanine aminotransferase 316 U/L, both of which were higher than normal. Creatine kinase is 82614U/L, which is 1,000 times higher than the normal value. These indicators all prove that Uncle Wu's kidney function has been severely damaged, and creatine kinase exists in skeletal muscle, brain and myocardium, and the most common clinical elevation occurs in patients with myocardial infarction.
But Uncle Wu did not have symptoms such as chest pain, chest tightness or dizziness and headache, and the electrocardiogram was normal, but the only two symptoms were muscle aches and soy sauce-colored urine. Just when the doctor was at a loss, he suddenly had an idea of a disease: rhabdomyolysis.
Rhabdomyolysis is a syndrome caused by severe damage to muscle tissue. When striated muscle cells are damaged, substances such as myoglobin or various toxins in the cells will be released into the cells and blood circulation, causing acute kidney damage and even kidney failure.
Rhabdomyolysis typically presents with a triad of myalgia, muscle weakness, and tawny urine (soy sauce-colored urine), which can lead to acute kidney injury in severe cases. Most patients with rhabdomyolysis have elevated creatine kinase levels and myoglobin on urinalysis.
People who are more susceptible to rhabdomyolysis have recently engaged in strenuous exercise, such as marathon running, weightlifting, bodybuilders, or people who don't exercise regularly but suddenly engage in heavy exercise. In April 2023, an 18-year-old girl in the flower season faced double leg amputation due to rhabdomyolysis due to sudden strenuous exercise.
Now all the clues are strung together, and all that needs to be done now is treatment. The primary principle of treatment for rhabdomyolysis is to identify the cause and cause, but how could Uncle Wu have rhabdomyolysis without participating in strenuous exercise or trauma? In order to find out the cause, the doctor carefully asked Uncle Wu about his lifestyle habits and medication history.
When Uncle Wu said atorvastatin, the doctor suddenly had an eyebrow. One of the side effects of atorvastatin is that it may cause myopathy, which is muscle pain or muscle weakness. But even patients who have been taking atorvastatin for more than ten years will not have such a serious rhabdomyolysis in a short period of time, not to mention that Uncle Wu takes the medicine accurately according to the doctor's instructions.
The doctor continued to look for the cause of the disease, and then he heard the name of another drug from Uncle Wu's mouth, and the doubts in his heart fell. It turns out that the reason why Uncle Wu has such severe rhabdomyolysis symptoms is because he took atorvastatin with this common medicine. If these two drugs are used together, it will be as short as 4-6 hours, and as long as half a year, rhabdomyolysis will definitely occur!
The medicine that Uncle Wu took was colchicine. Colchicine is a drug commonly used in clinical practice to treat acute exacerbations of gouty arthritis, and it may also cause rhabdomyolysis. When atorvastatin is taken with colchicine, atorvastatin restricts colchicine metabolism from the intestinal lumen outward, which increases the blood concentration of colchicine, which in turn increases the risk of rhabdomyolysis.
Colchicine is widely distributed in the body, hemodialysis and hemoperfusion are difficult to completely remove colchicine, at present, there is no specific antidote in clinical practice, only symptomatic and supportive treatment. When patients with gout are taking colchicine, special attention should be paid to the co-function of the liver and kidney, and if statins or macrolide antibiotics are taking at the same time, attention should be paid to whether there are symptoms of muscle pain and limb weakness in the process of taking the drug, and serum creatine kinase should be regularly tested to reduce the probability of rhabdomyolysis.
Patients who take statins for a long time should also pay attention to the following four points:
1. Take it on time and in accordance with the doctor's instructions
Atorvastatin has a half-life of more than 20 hours, a long metabolic time in the body, and a long-lasting effect, so there is no need to increase or decrease the dosage due to the rush to control blood lipids. Moreover, increasing the dosage of atorvastatin only increases the effect of lipid-lowering by 6%, but the adverse reactions will increase exponentially. Therefore, patients only need to take their medication according to the doctor's medication instructions.
2. Pay attention to adverse reactions
The common adverse reactions of atorvastatin include muscle pain, increased liver aminotransferases, blood sugar height, gastrointestinal irritation, etc., during taking atorvastatin, it is necessary to pay attention to whether the above adverse reactions occur, and the liver and kidney function should be regularly reviewed during the period of taking the drug, and the safety and toxicity of the drug should be paid attention to.
3. Pay attention to the combination of drugs
Because atorvastatin is metabolized by the liver enzyme CYP3A4, which is a common metabolic enzyme of many drugs, therefore, during the period of taking atorvastatin, if you want to take other drugs, you should pay attention to the occurrence of interactions, such as antifungal drugs such as itraconazole and fluconazole, as well as macrolide antibacterial drugs such as azithromycin and clarithromycin, and inform the doctor of your disease history and drug history in advance to prevent adverse reactions.