Rhabdomyolysis after midazolam administration in a cirrhotic patient treated with atorvastatin

Abstract

The administration of statins in patients with liver disease is not an absolute contraindication. Hepatotoxicity is a rare and often dose-related event and in the literature there are only a few described cases of fatal rhabdomyolysis in patients with chronic liver disease after statin administration. During treatment with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, the factors responsible for myopathy may either be related to the patient, or due to interactions with other medications that are metabolic substrates of the same isozymes and therefore able to increase blood statin concentration. The most important side effects consist of increased transaminase levels, abdominal pain or muscle weakness, increased serum levels of creatine kinase and rhabdomyolysis. In this article we report a case of fatal rhabdomyolysis with acute renal failure after gastric endoscopy, where midazolam was used as a sedation agent in a patient with chronic liver disease treated with a high dose of atorvastatin. Therefore, we suggest paying particular attention to the potential risks of associating atorvastatin and midazolam in patients with chronic liver disease who need to undergo gastric endoscopy.

Keywords: Rhabdomyolysis, Chronic liver disease, Statins, Midazolam, Alcoholic liver cirrhosis

Core tip: When dealing with alcoholic liver disease, clinicians need to pay particular attention to the administration of drugs, their dosage, interactions and metabolism to avoid severe adverse reactions. Cirrhotic patients on treatment with statins (particularly atorvastatin) are at high risk of developing fatal rhabdomyolysis and acute renal failure when midazolam is used to allow gastric endoscopy.