MONOTHERAPY EZETIMIBE-INDUCED RHABDOMYOLYSIS

Therapeutic Area

Pharmacologic Therapy

Case Presentation

A 62-year-old female with a past medical history of type one diabetes, coronary artery disease, hyperlipidemia, and previous statin-induced rhabdomyolysis presented with one month of worsening muscle pain. Two months ago, she was started on monotherapy ezetimibe 10mg daily. On presentation, labs were notable for creatine kinase of 2509 U/L (normal: 51-296 U/L) (figure 1), creatinine of 1.5 mg/dL with baseline 0.9 mg/dL (normal 0.6-1.0 mg/dL), and urinalysis with myoglobinuria. IV fluids and pain medications were started. Given normal autoimmune panel and thyroid labs with no other precipitating events, the decision was made to discontinue ezetimibe. Creatine kinase trended to normal levels of 186 U/L (figure 1) within 3 days of discontinuation. Her myalgias improved and she was started on a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor outpatient.

Background

Ezetimibe is often used in the setting of statin-induced myopathy. We report a rare case of monotherapy ezetimibe-induced rhabdomyolysis in a patient with previous history of rhabdomyolysis due to statins.

Conclusions

Previous cases in literature have reported combined ezetimibe/statin induced myopathy or rhabdomyolysis. However, monotherapy ezetimibe should also be considered in the differential for patients presenting with myopathy or rhabdomyolysis. More research needs to be performed in patients with previous myopathy due to statins to elucidate if they are at increased risk with ezetimibe as well. In these patients, PCSK9 inhibitors should be considered as an alternative treatment option.