Quinine induced simvastatin toxicity through cytochrome inhibition - a case report.

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Just JM, Weckbecker K, Just KS

Quinine induced simvastatin toxicity through cytochrome inhibition - a case report.

BMC Geriatr. 2016 Oct 1;16(1):168. doi: 10.1186/s12877-016-0337-8.

PubMed ID

27716084 [ View in PubMed

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Abstract

BACKGROUND: Nocturnal leg cramps are painful, involuntary muscle contractions commonly seen in elderly. While mostly harmless, they can severely impair quality of life and often disrupt sleep. Adverse drug effects may be responsible for a fraction of nocturnal leg cramps but often go unrecognized, resulting in additional prescribing intended to deal with adverse effects that might be better addressed by reduction, substitution, or discontinuation of the offending agent. CASE PRESENTATION: An 87 year old female presented as outpatient in family medicine with nocturnal leg cramps which had been present for five years and increasingly burdened her quality of life. She had been using quinine 200 mg once daily for symptomatic relief but the cramps kept returning with increasing intensity. During clinical examination we found neither structural nor neurological or metabolic disorders that explained her symptoms. When doing a medication analysis, we found that she was taking a statin together with quinine. Quinine is a cytochrome P450 isoenzyme 3A4 inhibitor, the very enzyme which is involved in the metabolism of most statins. Therefore the use of both substances simultaneously increases blood levels of the statin thereby increasing the risk of side effects including symptomatic myopathy and myalgia. After discontinuing both medications, the patient was, and remained, symptom free. CONCLUSION: This case report describes a possible medication interaction that has rarely been noted in literature.

DrugBank Data that Cites this Article

Drug Enzymes

Drug	Enzyme	Kind	Organism	Pharmacological Action	Actions
Quinine	Cytochrome P450 3A4	Protein	Humans	Unknown	Substrate Inhibitor Inducer	Details