A 63-year-old woman previously stable on a regimen of atorvastatin 40?mg daily, carvedilol 25?mg twice daily, digoxin 0.125?mg daily, furosemide 40?mg daily, spironolactone 25?mg daily, rivaroxaban 15?mg daily, and enalapril 20?mg twice daily for heart failure developed rhabdomyolysis 26?days after enalapril was stopped and sacubitril/valsartan (Entresto?) started. The patient received sacubitril/valsartan at 24/26?mg twice daily for heart failure; however, after 26?days she developed muscle and skin pain. Investigations revealed elevated creatine kinase and liver function tests, and rhabdomyolysis with raised transaminases was diagnosed. Sacubitril/valsartan and atorvastatin were discontinued and the patient was hydrated. She returned to baseline in 23?days and has not had any reoccurrence of rhabdomyolysis and elevated transaminases for 46?days. A Naranjo assessment score of 5 was obtained, indicating a probable relationship between the patient’s rhabdomyolysis and her use of sacubitril/valsartan. The Drug Interaction Probability Scale score was 3, consistent with a possible interaction as a cause for the reaction, with sacubitril/valsartan as the precipitant drug and atorvastatin as the object drug.
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