||July 27, 2006
An Exclusive Continuing Education Publication of Acadiana Consultant Pharmacy Service
Author, Publisher, Editor-in Chief, Typesetter & Printer, Charles S. Feucht,PD,FASCP PharmD candidate
Medication News & Update
Rhabdomyloysis is a musle condition in which the cells in the muscle are damaged and die resulting in muscle weakness, cramping, pain and complications ranging from kidney failure, cardiac arrythmias and even death. Most patients with drug-induced rhabdomyolysis do not complain of swelling or tenderness over the involved muscle. Patients may develop a "second wave phenomenon" in which a delayed increase in fascial compartment pressure causes compression related nerve problems , swelling, and tenderness. Compartment syndromes in drug-induced rhabdomyolysis usually occur secondary to prolonged immobilization or coma, which can result in contractures and amputations
Rhabdolyolysis can result from numerous causes. Some of these include the following:
- Direct muscle injury, such as from animal bites, burns, crush injuries, electrocution, fights or beatings, or high-impact trauma
- Drugs or toxins, including illegal drugs, alcohol, caffeine, venom, and adverse reactions to statins. (Patients taking statins for hyperlipidemia should have their CK levels carefully monitored along with their blood lipids and liver enzymes. Patients are at higher risk for statin-induced rhabdomyolysis if they have renal impairment, hypothyroidism, a personal or family history of hereditary muscle disorders, history or muscular toxicity with another statin or a fibrate, abuse alcohol, are of Japanese or Chinese ethnicity, or also take a fibrate.) There have been several case reports in the literature involving some drugs that are associated with rhabdomyolysis. Diphenhydramine, Ecstasy, and baclofen have recently been implicated as the etiology of drug-induced rhabdomyolysis
- Hypoxia, such as from arterial embolism, carbon monoxide poisoning, compartment syndrome, constrictive dressings or casts, drowning, hypotension, prolonged immobility, shock, sickle-cell crisis, or tourniquet use
- Infection, including human immunodeficiency virus, influenza virus, sepsis, tetanus, or toxic shock syndrome
- Muscle overuse, as from delirium tremens, seizures, severe agitation, strenuous exercise, or tetany
- Systemic imbalances such as hyperosmolar hyperglycemic nonketotic coma, hypokalemia, hyponatremia, or thyroid storm
- Temperature extremes, such as frostbite, hyperthermia, hypothermia, or malignant hyperthermia.
While rhabdomyolysis is a serious condition and may become life threatening early recognition, and adequate treatment will result in an excellent prognosis of drug-induced rhabdomyolysis.