Elevated serum transaminase levels resulting from concomitant use of rosuvastatin and amiodarone

• Published in: American journal of health-system pharmacy 2007-09, Vol.64 (17), p.1818-1821
• Main Authors: Merz, Tonja, Fuller, Stephen H
• Format: Article
• Language: English
• Subjects: Aged; Alanine Transaminase - blood; Aminotransferases; Amiodarone; Amiodarone - adverse effects; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Aortic Valve - transplantation; Aortic Valve Stenosis - blood; Aortic Valve Stenosis - surgery; Aspartate Aminotransferases - blood; Complications and side effects; Dosage and administration; Drug Interactions; Female; Fluorobenzenes - adverse effects; Fluorobenzenes - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hyperlipidemias - blood; Hyperlipidemias - drug therapy; Physiological aspects; Pyrimidines - adverse effects; Pyrimidines - therapeutic use; Rosuvastatin; Rosuvastatin Calcium; Sulfonamides - adverse effects; Sulfonamides - therapeutic use
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp060305

The case of a patient whose serum transaminase levels became elevated after concomitant use of rosuvastatin and amiodarone is described. A 73-year-old white woman with a medical history of diabetes mellitus, hypertension, hypothyroidism, hyperlipidemia, and aortic stenosis reported to a clinic on February 9, 2006. Laboratory tests revealed the following values: total cholesterol, 172 mg/dL; low-density-lipoprotein cholesterol, 96 mg/dL; high-density-lipoprotein cholesterol, 55 mg/dL; triglycerides, 105 mg/dL; aspartate transaminase (AST), 14 IU/L; alanine transaminase (ALT), 13 IU/L; alkaline phosphatase (ALP), 68 IU/L; and serum creatinine (SCr), 1.1 mg/dL. At this time, rosuvastatin 5 mg daily was initiated. On April 20, 2006, laboratory tests revealed an AST of 30 IU/L, ALT of 58 IU/L, ALP of 99 IU/L, and SCr of 1.0 mg/dL. Because of the severity of her aortic stenosis, the patient underwent aortic valve replacement on May 15, 2006, and amiodarone was initiated. Laboratory tests completed on May 31, 2006, revealed an AST of 192 IU/L, ALT of 336 IU/L, ALP of 322 IU/L, and SCr of 1.1 mg/dL. She did not report any symptoms of myopathy or liver dysfunction. Ultrasound revealed no liver abnormalities. The rosuvastatin was discontinued because of a potential interaction with the amiodarone. One week after the rosuvastatin was stopped, her laboratory tests showed an AST of 68 IU/L, an ALT of 126 IU/L, an ALP of 292 IU/L, a creatine kinase concentration of 22 IU/L, and an SCr of 1.0 mg/dL. Two months later, her liver function test values had continued to decline. A potential interaction between rosuvastatin and amiodarone resulted in asymptomatic elevation of serum transaminase levels in a 73-year-old woman.