Fluvastatin與Fusidic acid引發橫紋肌溶解症及急性肝、腎異常之案例報告與文獻回顧

Case Report and Literature Review of Rhab domyolysis and Acute Liver and Kidney Abnormalities Caused by Fluv astatin and Fusidic Acid

已知夫西地酸(Fusidic acid, FA)與他汀類(Statin)的阿托伐他汀(at orvastatin)或辛伐他汀 (simvastatin)合併用藥時，由於FA抑制Statin的代謝與運送，降低Statin的清除率，進而引起橫紋肌溶解症，但FA併用Statin類的氟伐他汀(Fluvastatin)發生藥物副作用的臨床案例極為罕見。本案例89歲男性，主訴全身極度倦怠虛弱，實驗室檢測肌酸激酶CK:10,000 U/L；轉胺酶AS T/ALT：787/1163 U/L、血尿素氮和肌酸酐比率(BUN/Creatinine ratio) 43.9、D-Dimer：1406.86 ng/mL，檢驗數據顯示嚴重橫紋肌溶解併發急性肝、腎異常，疑似為藥物併用導致；本文藉由案例與文獻回顧探討藥物的潛在風險，對於多重就醫、多科看診的個案，建議在給藥前應審慎權衡臨床療效與不良反應風險的輕重，在給藥後定期追蹤、評估，於必要時調整藥物處方，以降低非預期性的藥物不良反應。

Combination therapy of fusidic acid (FA) with statins suc h as atorvastatin or simvastatin is known to result in decreased statin clearance and an inhibition of statin me tabolism and transport, leading to rhabdomyolysis. However, clinical cases of adverse drug reactions with FA in combination with fluvastatin, another statin, are extremely rare. We present a case of an 89-year-old ma le who complained of severe fatigue and weakness t hroughout his body. Laboratory tests showed elevated c reatine kinase (CK) levels at 10,000 U/L, aspartate t ransaminase (AST)/alanine transaminase (ALT) levels at 787/1163 U/L, blood urea nitrogen to creatinine ( BUN/Creatinine) ratio at 43.9, and D-dimer at 14 06.86 ng/mL. The test results indicated severe rhabdomyolysis with acute liver and kidney abnormalitie s, likely induced by the combined use of medications. In this article, we discuss the potential risks of medication interactions based on the case and review of relevant l iterature. For patients receiving multiple medications fro m different healthcare providers, it is recommended t o carefully weigh the clinical benefits against the risks of adverse reactions before prescribing medications. Regular monitoring and evaluation after medication a dministration, with appropriate adjustments, when necessary, can help reduce unexpected adverse drug reac tions.