Beware of the precursors of drug-induced rhabdomyolysis: flu-like symptoms

"Lobsters and alcohol, no muscles!" What does this mean? In fact, it is eating a lot of crayfish or drinking a lot of alcohol that causes rhabdomyolysis. Not only that, in fact, many drugs can also cause rhabdomyolysis, and flu-like symptoms are likely to be a precursor to drug-induced rhabdomyolysis.

Rhabdomyolysis is a type of disease characterized by damage or dissolution of muscles (striated skeletal muscles). The clinical symptoms may appear locally or may affect the whole body, and are often manifested as: acute muscle pain, muscle cramps, muscle edema, nausea, vomiting, soy sauce-colored urine, muscle weakness, lameness, etc.

①What causes rhabdomyolysis?

According to foreign research, there are more than 200 causes of rhabdomyolysis, and the causes cover many aspects and are very complex. Common factors include the following: first, external stimulation, such as strenuous exercise or gravity squeezing the muscles, which may lead to rhabdomyolysis; in addition, improper consumption of certain foods or toxic substances may also lead to rhabdomyolysis, and the most reported is drinking a lot of alcohol or eating a lot of crayfish; and some adverse drug reactions may lead to rhabdomyolysis.

②Which drugs can cause rhabdomyolysis?

According to incomplete statistics, there are more than 150 drugs that can cause severe muscle damage. Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (simvastatin, pravastatin, atorvastatin, etc.), quinolone antibiotics (floxacins), anti-hepatitis virus drugs (lamivudine and telbivudine), β2 receptor agonists (terbutaline, salbutamol, etc.), drugs that cause hypokalemia (furosemide, hydrochlorothiazide, indapamide, compound glycyrrhizin, amphotericin B, etc.), anesthetic psychotropic drugs (opioids, barbiturates, phenothiazines, succinylcholine, etc.), and other drugs (theophylline, amiodarone, donepezil, colchicine, diphenhydramine, cyclosporine A, itraconazole, erythromycin, corticosteroids, etc.) all have direct damaging effects on skeletal muscle; central nervous system depressants, cocaine, amphetamines, lysergic acid diethylamide and other drugs have indirect damaging effects on skeletal muscle.

③So many drugs may cause rhabdomyolysis, how can we prevent it?

First of all, we must follow the doctor's instructions to use the medicine. Rational use of medicine is the most effective choice to improve the safety of the medicine. Secondly, we need to understand the specific symptoms of rhabdomyolysis and do self-prevention.

Patients with severe rhabdomyolysis may experience a typical triad of symptoms: muscle pain, fatigue, and dark urine. However, only a few patients have such obvious symptoms. Most patients will experience flu-like symptoms that are not very specific, such as fever, nausea, vomiting, fatigue, muscle pain, etc., and may also be accompanied by abdominal pain. These symptoms can easily make us mistake them for ordinary flu.

Here, the pharmacist emphasizes that people who take medications for a long time, especially statins, anti-infective drugs, and hormone drugs, who need to take medications for a long time or continue to take medications for a period of time, should pay more attention if they have flu-like symptoms similar to the above, seek medical attention in time, and inform the doctor of the medications you are taking. This will be very helpful in helping the doctor diagnose whether you are at risk of rhabdomyolysis.

It is also worth reminding that the clinical manifestations of rhabdomyolysis are related to the severity, and there are great clinical differences. About 50% of patients do not have muscle symptoms. At this time, it is very important to go to the hospital for laboratory tests. Therefore, patients who take drugs that may cause rhabdomyolysis for a long time should take the initiative to go to the hospital every 1-3 months to test relevant indicators to ensure the safety of medication.

References:

[1] Zhong Aifang, Wen Jianli, Chen Yuxiu, et al. Current status of research on rhabdomyolysis[J]. Journal of Chengde Medical College, 2020, 37(1): 69-73.

[2]RAWSON ES, CLARKSON PM, TARNOPOLSKY M A.Perspectives on exertional rhabdomyolysis[J]. Sports Med, 2017,47(Suppl 1): 33-49.

[3] Zhang Yaqin, Guo Ping. Comprehensive treatment of drug-induced rhabdomyolysis[J]. Northwest Journal of Pharmacy, 2006, 21(4): 179-179.

[4] Shen Yulan, Zhang Xiancui, Sun Panpan, et al. Nursing experience of 103 patients with rhabdomyolysis syndrome caused by eating crayfish[J]. Journal of Wannan Medical College, 2019, 38(2): 193-195.