Rhabdomyolysis due to overdosage of bezafibrate in a patient with uremia

A 51-year-old male patient with hyperlipidemia, uremia, uremic cardiomyopathy, hypertension, osteoporosis and type 2 diabetes received atorvastatin calcium 20 mg/d, olmesartan 20 mg/d, nifedipine 30 mg/d, isosorbide 5-mononitrate 40 mg/d, calcitriol 0.5 μg/d, calcium acetate 0.6 g/d. In addition, the patient received hypodermic injection of insulin according to blood sugar level, and maintained peritoneal dialysis. The patient stopped using atorvastatin and switched to bezafibrate dispersible tablets 0.2 g three time daily because of his high levels of total cholesterol (7.0 mmol/L) and triacylglycerol (9.9 mmol/L) . On day 4 of changing the prescription, the patient complained of whole body pain. On day 6 of changing the prescription, the patient became anxious, irritable, and had darkened peritoneal dialysis fluid. Laboratory test showed the following values: white blood cell count (WBC) 33.0×109/L, neutrophil 0.95, creatine kinase (CK) >10 000 U/L, myoglobin 2 876 μg/L, alanine aminotransferase (ALT) 460 U/L, urea 20.9 mmol/L, and creatinine (Cr) 1 294 μmol/L on day 7 of changing medical prescription. The patient was diagnosed as rhabdomyolysis due to bezafibrate. Bezafibrate was withdrawn on the same day. He received the symptomatic treatments including liver and kidney protection, nourishing myocardium, and vein-vein hemodialysis besides continuing to take the other drugs mentioned above. On day 7 of stopping bezafibrate the patient's mental symptoms improved. Laboratory test showed the following values: WBC 16.0×109/L, neutrophil 0.81, CK 154 U/L, myoglobin 288 μg/L, ALT 21 U/L, urea 12.0 mmol/L, and Cr 564 μmol/L on day 16 of stopping bezafibrate.The patient did not complain of pain, the symptoms of anxiety and irritability did not appear until the day 60 of drug withdrawal. Key words: Bezafibrate; Rhabdomyolysis; Uremia