Potentially Fatal Interaction between Diltiazem and Statins
Authors: Patrick Gladding
Journal: Annals of Internal Medicine (2004)

Letters20 April 2004Potentially Fatal Interaction between Diltiazem and StatinsPatrick Gladding, MBCHB, BHB, Helen Pilmore, MBCHB, FRACP, MD, and Colin Edwards, MBBCH(WITS), FCP(SA), FRACPPatrick Gladding, MBCHB, BHBFrom Auckland Healthcare Services Ltd., Grafton, and North Shore Hospital, Takapuna, Auckland, New Zealand.Search for more papers by this author, Helen Pilmore, MBCHB, FRACP, MDFrom Auckland Healthcare Services Ltd., Grafton, and North Shore Hospital, Takapuna, Auckland, New Zealand.Search for more papers by this author, and Colin Edwards, MBBCH(WITS), FCP(SA), FRACPFrom Auckland Healthcare Services Ltd., Grafton, and North Shore Hospital, Takapuna, Auckland, New Zealand.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-8-200404200-00037-w1 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: The interaction of diltiazem and statins, metabolized through cytochrome P450 3A4, leads to increased risk for rhabdomyolysis.Objective: To describe the interaction between diltiazem and simvastatin–atorvastatin and highlight its clinical significance.Case Reports: In case 1, a 59-year-old woman receiving long-term ambulatory peritoneal dialysis because of diabetes-induced renal failure presented with an ischemic toe. She was taking atorvastatin, 40 mg/d; aspirin; glyceryl trinitrate; isosorbide mononitrate; insulin; metoclopramide; vitamin D; omeprazole; calcium; and erythropoietin. She had been taking atorvastatin for more than 1 year.The patient developed angina, and diltiazem therapy was started; the daily dose was ...References1. Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis [Letter]. N Engl J Med. 2002;346:539-40. [PMID: 11844864] CrossrefMedlineGoogle Scholar2. Flint OP, Masters BA, Gregg RE, Durham SK. HMG CoA reductase inhibitor-induced myotoxicity: pravastatin and lovastatin inhibit the geranylgeranylation of low-molecular-weight proteins in neonatal rat muscle cell culture. Toxicol Appl Pharmacol. 1997;145:99-110. [PMID: 9221829] CrossrefMedlineGoogle Scholar3. Galper JB. Increased incidence of myositis in patients treated with high-dose simvastatin [Letter]. Am J Cardiol. 1998;81:259. [PMID: 9591920] MedlineGoogle Scholar4. Mousa O, Brater DC, Sunblad KJ, Hall SD. The interaction of diltiazem with simvastatin. Clin Pharmacol Ther. 2000;67:267-74. [PMID: 10741630] CrossrefMedlineGoogle Scholar5. Bae J, Jarcho JA, Denton MD, Magee CC. Statin specific toxicity in organ transplant recipients: case report and review of the literature. J Nephrol. 2002;15:317-9. [PMID: 12113605] MedlineGoogle Scholar6. Kanathur N, Mathai MG, Byrd RP, Fields CL, Roy TM. Simvastatin-diltiazem drug interaction resulting in rhabdomyolysis and hepatitis. Tenn Med. 2001;94:339-41. [PMID: 11550401] MedlineGoogle Scholar7. Peces R, Pobes A. Rhabdomyolysis associated with concurrent use of simvastatin and diltiazem [Letter]. Nephron. 2001;89:117-8. [PMID: 11528245] CrossrefMedlineGoogle Scholar8. Lewin JJ, Nappi JM, Taylor MH. Rhabdomyolysis with concurrent atorvastatin and diltiazem. Ann Pharmacother. 2002;36:1546-9. [PMID: 12243603] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Auckland Healthcare Services Ltd., Grafton, and North Shore Hospital, Takapuna, Auckland, New Zealand. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPharmacologic InteractionsPotential statin-drug interactions: prevalence and clinical significanceThe Effect of Atorvastatin on Liver Function among Patients with Coronary Heart Disease in Gaza StripSimvastatin-induced myopathy, the role of interaction with diltiazem and genetic predispositionEffects of Concomitant Therapy with Diltiazem on the Lipid Responses to Simvastatin in Chinese SubjectsPharmacologic Interactions in the CICUComputing with evidenceRhabdomyolysis Caused by a Potential Sitagliptin-Lovastatin InteractionPharmacokinetic Comparison of the Potential Over-the-Counter Statins Simvastatin, Lovastatin, Fluvastatin and PravastatinSafety Issues with Statin TherapyAdverse effects of statins 20 April 2004Volume 140, Issue 8Page: W-31KeywordsAttentionCase seriesCreatine kinaseDrugsEnzymesInsulinMedical dialysisRenal failureRhabdomyolysisStatins ePublished: 20 April 2004 Issue Published: 20 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...