Analysis of a serious adverse reaction of rhabdomyolysis precipitated by a possible interaction of methylprednisolone with atorvastatin: a case report

A man in his 80s had been taking atorvastatin for 2 months for hyperlipidaemia. Due to the recurrence of nephrotic syndrome, methylprednisolone, torasemide, benidipine and atorvastatin were prescribed after admission to hospital. While his dyspnoea and oedema improved with diuretic therapy, the patient reported significant muscle soreness 8 days after starting the combined atorvastatin and methylprednisolone. Simultaneously, creatine kinase and myoglobin levels increased significantly. The temporal correlation between the drug combination and symptom onset, coupled with rapid clinical and biochemical improvement after atorvastatin discontinuation, supported a diagnosis of rhabdomyolysis due to a potential drug-drug interaction between atorvastatin and methylprednisolone, likely exacerbated by hypoproteinaemia. This case highlights the need for clinicians and pharmacists to be vigilant for such drug-drug interactions, particularly in patients with predisposing conditions like hypoproteinaemia.