Ication. She was allergic to penicillin. She performs as a medical secretary, drinks alcohol sometimes and does not smoke. Clinical examination was normal, with no clinical evidence of muscle tenderness or weakness.DISCUSSIONQuestions being asked: what is the incidence of statin-induced rhabdomyolysis, what would be the predictors and could be the effect dose dependent To what extent ought to we limit statin use in those that have had prior statin unwanted effects Search tactic: PubMed search making use of `simvastatin’, `simvastatin 80 mg’, `rhabdomyolysis’, `statin induced rhabdomyolysis’. Conclusions becoming drawn: this case reminds us of the serious complications of statin therapy andINVESTIGATIONSOn admission her creatine kinase was 426 700 (reference variety 968 IU/L). Her liver function tests have been also deranged, having a raised alanine transaminase (ALT) of 409 IU/L (reference range 05 IU/L). Her ALT had been standard 6 days before admission (19 IU/L). Her other liver enzymes were standard, like alkaline phosphatase and bilirubin. Her creatinine remained normal throughout. Admission urinalysis showed significant haematuria and proteinuria. Her ECG showed standard sinusTo cite: Tayal U, Carroll R. BMJ Case Rep Published on-line: [ please involve Day Month Year] doi:10.1136/ bcr-2013-Figure 1 kinase.A graph outlining the trend in serum creatineTayal U, et al. BMJ Case Rep 2013. doi:ten.1136/bcr-2013-Unexpected outcome ( good or adverse) which includes adverse drug reactionswarns us not to ignore the patient’s previous experiences with statins. Myalgias are popular in patients taking statins but rhabdomyolysis is rare. The incidence was estimated as 4/100 000 person-years in one particular study.1 The risk increases with concurrent medication including fibrates and drugs that inhibit the CYP3A4 isoenzyme (through which statins are metabolised), for example, calcium channel blockers, rising age and liver dysfunction. This patient didn’t have any of these danger components. Nevertheless, as illustrated within this case, the rhabdomyolysis risk can also be dose dependent, estimated as up to 10 times increased threat of rhabdomyolysis with simvastatin 80 mg in comparison to moderate dosing.2 Simvastatin in distinct will be the most notable on the statins for this3 but not exclusively; high-dose atorvastatin has equivalent troubles.four In 2011, the Food and Drug Administration(FDA ) in the USA issued a statement that simvastatin 80 mg need to no PI3K Inhibitor Formulation longer be prescribed de novo and only continued in αLβ2 Inhibitor Molecular Weight individuals that have tolerated that dose for more than 1 year.five If lipid manage is just not achieved making use of simvastatin 40 mg, then trialling an option statin is encouraged as an alternative to uptitrating simvastatin. Mild myalgias are frequent symptoms with statins. They ought to settle within a couple of months upon discontinuation in the drug. If however that you are to restart a statin then it is prudent to attempt a lower dose of a distinctive statin to that which induced the myalgia. Recent observational function supports the efficacy of intermittent dosing of rosuvastatin (eg, 5 mg three instances a week)six or atorvastatin7 which could possibly be helpful in patients intolerant of greater doses of statins. Statins are crucial drugs in the pharmacological armamentarium to lessen all round cardiovascular danger and we understand that intensive lipid lowering reduces cardiovascular risk, in unique in high-risk patient groups including these with proven cardiovascular events at a young age. Balancing the possible cardiovascular advantage of statins versus the potential side e.