Rhabdomyolysis associated with fibrate therapy: review of 76 published cases and a new case report

Fibrates are used to manage mixed dyslipidemia. However, these drugs have the potential risk of inducing rhabdomyolysis. This paper gives an overview of the literature on rhabdomyolysis associated with fibrate therapy. We reported a case of rhabdomyolysis induced by fenofibrate and reviewed the published rhabdomyolysis cases associated with fibrate therapy. Seventy-six published rhabdomyolysis cases associated with fibrates were evaluated, and a nondiabetic, nonhypertensive patient who presented with rhabdomyolysis caused by fenofibrate was reported. The onset time of the reaction varied between 36 h and 6 months. Gemfibrozil was the most frequent agent associated with rhabdomyolysis, followed by bezafibrate, fenofibrate, ciprofibrate, and clofibrate. Twenty-three cases were associated with fibrate monotherapy and 54 with fibrate therapy combined with statins or other drugs potentially interacting with fibrates. Sixteen cases had chronic renal failure before fibrate therapy, and 6 had hypothyroidism. Fifty-four complicated acute renal failure. After discontinuation of the fibrates and hydration, most patients recovered. Chronic renal failure may be a risk factor for rhabdomyolysis associated with fibrates. Although rhabdomyolysis usually occurred when fibrates were combined with statins, a well-known class of agents that potentially induce rhabdomyolysis, precautions against serious adverse effects should also be taken with fibrate monotherapy.