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The second case to
be considered is that of potentially lethal skeletal muscle damage, rhabdomyolysis,
occurring in association with concomitant use of fluconazole (Diflucan®)
and atorvastatin (Lipitor®).1
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Excessive levels of
drugs that inhibit HMG CoA can cause muscle injury by mechanisms that are not
entirely clear.2 This can
cause a massive release of myoglobin into the bloodstream, and this protein
causes renal tubular obstruction, leading to potentially lethal renal
insufficiency or failure.
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1. Kahri J,
Valkonen M, Backlund T, Vuoristo M, Kivisto KT. Rhabdomyolysis in a patient
receiving atorvastatin and fluconazole. Eur J Clin Pharmacol 2005;
60(12):905-907. 2. Radcliffe KA, Campbell WW. Statin myopathy. Curr
Neurol Neurosci Rep 2008; 8(1):66-72.
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