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  • 1 Szent Lázár Megyei Kórház Belgyógyászati Osztály Salgótarján Salgó út 4. 3100
  • | 2 Szent Lázár Megyei Kórház Fresenius MC Dialízis Központ Salgótarján
  • | 3 Szent Lázár Megyei Kórház Intenzív Osztály Salgótarján
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A simvastatin (SIM) ritka és súlyos mellékhatása a harántcsíkolt izomzat szétesése, a rhabdomyolysis (RML). A folyamat patogenezisében több rizikófaktor szerepét leírták, mint például a >65 év, cukorbetegség, vesebetegség, nagy adagban adott statinkezelés, citokróm P450 3A4 útján metabolizálódó vegyületek vagy az egyéni érzékenység. Esetismertetés: A fentiek közül négy rizikófaktorral rendelkező 66 éves férfi betegünk 2-es típusú diabetes, ISZB és hypertonia miatt állt kezelés alatt. CYP3A4-szubsztrát amlodipint és alprazolamot kapott. Ismeretlen kiindulási koleszterinszint mellett maximális dózisú SIM-kezelés indult. Másnapra vizeletelszíneződés, paraparesis, a negyedik napra tetraparesis és oliguria jellemezte a heveny veseelégtelenséggel járó RML kialakulását. A százhat nap kórházi ápolás alatt negyvenkilenc alkalommal részesült dialíziskezelésben. Elbocsátás utáni tizenhat hónap utánkövetés alatt a beteg járása oly mértékben javult, hogy egy járóbot segítségével közlekedik. Következtetések: A fent említett rizikófaktorok miatt, ebben az esetben, alacsony kezdő dózisú SIM alkalmazása lett volna kívánatos. Izomfájdalom vagy gyengeség kialakulásakor a kezelés leállítása indokolt. RML-re hajlamosító tényezők esetén a statinkezelés és adagjának emelése szoros ellenőrzés mellett történhet.

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