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Gaisenok OV, Chichkov YM, Leonova MV. The Problem of Drug Interactions Between Rosuvastatin and Ticagrelor in the Aspect of the Risk of Rhabdomyolysis: Discussion of the Problem and Description of the Clinical Case. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background. Combination therapy with two antiplatelet agents (ticagrelor or clopidogrel plus acetylsalicylic acid) and a high dose statin is recommended in accordance with clinical guidelines for patients undergoing acute coronary syndrome and coronary intervention. Combined therapeutic regimens have drug-drug interaction potential. Rhabdomyolysis is a known side effect of statin therapy, and there is evidence that co-therapy with ticagrelor increases the risk of this complication.Case description. A 72-year-old female patient was hospitalized with typical signs of rhabdomyolysis: muscle pain, oliguria, weakness, significant increases in creatine kinase (CK), myoglobin and creatinine. One month before that, she was urgently hospitalized with acute recurrent ST-elevation myocardial infarction and underwent endovascular intervention on a critical stenosis of the left anterior descending artery with stent implantation. After that, rosuvastatin 40 mg per day and ticagrelor 90mg 2 times a day were added to her therapy. During the current hospitalization, rosuvastatin, ACE inhibitors and spirolactone were canceled, infusion therapy was carried out, which led to a rapid regression of symptoms, restoration of adequate diuresis, and normalization of CK, myoglobin and creatinine levels. Conclusions. The combined use of ticagrelor with rosuvastatin (especially at a high dose) increases the risk of rhabdomyolysis in elderly patients. Patients taking ticagrelor may require changes in statin therapy, dose adjustments, and possible drug changes to avoid pharmacological interactions and an increased risk of side effects.
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Affiliation(s)
- O. V. Gaisenok
- United Hospital with Outpatient Department of the Administrative Department of the President of the Russian Federation
| | - Yu. M. Chichkov
- United Hospital with Outpatient Department of the Administrative Department of the President of the Russian Federation
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Scailteux LM, Despas F, Balusson F, Campillo-Gimenez B, Mathieu R, Vincendeau S, Happe A, Nowak E, Kerbrat S, Oger E. Hospitalization for adverse events under abiraterone or enzalutamide exposure in real-world setting: A French population-based study on prostate cancer patients. Br J Clin Pharmacol 2021; 88:336-346. [PMID: 34224605 DOI: 10.1111/bcp.14972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Safety profiles of abiraterone and enzalutamide rely mainly on Phase III clinical trials. Our objective was to estimate the incidence rate ratio (IRR) for certain adverse events leading in real life to hospitalization (atrial fibrillation, acute heart failure, ischaemic heart disease, acute kidney injury [AKI], ischaemic stroke, torsade de pointe/QT interval prolongation, hepatitis and seizure), comparing abiraterone to enzalutamide. We also set out to discuss previously identified safety signals. METHOD Using the French National Health Insurance System database, all patients newly exposed to abiraterone or enzalutamide between 2013 and 2017 and followed until 31 December 2018 were targeted. IRRs for each event were estimated using a Poisson model in a sub-population of patients without contraindications or precautions for use for either treatment. RESULTS Among 11 534 new users of abiraterone and enzalutamide, AKI (IRR 1.42, 95% CI: 1.01-2.00), liver monitoring suggestive of hepatic damage (IRR 3.06, 95% CI: 2.66-3.53) and atrial fibrillation (IRR 1.12, 95% CI: 1.05-1.19) were significantly more often observed with abiraterone than with enzalutamide. CONCLUSION Our study provides knowledge on abiraterone and enzalutamide real-life safety profiles, especially for events leading to hospitalization. Despite several limitations, including the lack of clinical data, the safety signal for AKI under abiraterone is in line with results of an analysis of the French pharmacovigilance database, which requires further specific investigations. Enlightening the clinicians' therapeutic choices for patients treated for prostate cancer, our study should lead to clinicians being cautious in the use of abiraterone.
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Affiliation(s)
- Lucie-Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France.,EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Univ Rennes, Rennes, France.,PEPS research consortium, Rennes, France
| | - Fabien Despas
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.,INSERM CIC 1436 Toulouse, Centre d'Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, France
| | - Frédéric Balusson
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Boris Campillo-Gimenez
- Eugène Marquis Comprehensive Cancer Regional Center, Rennes, France.,INSERM 1099 'LTSI', Univ Rennes, Rennes, France
| | - Romain Mathieu
- Urology Department, Rennes University Hospital, Rennes, France.,CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | | | - André Happe
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Univ Rennes, Rennes, France.,PEPS research consortium, Rennes, France
| | - Emmanuel Nowak
- PEPS research consortium, Rennes, France.,Université de Bretagne Loire, Université de Brest, INSERM CIC 1412, CHRU de Brest, France
| | - Sandrine Kerbrat
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Univ Rennes, Rennes, France.,PEPS research consortium, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France.,EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Univ Rennes, Rennes, France.,PEPS research consortium, Rennes, France
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