Rosuvastatin Toxicity Observed After Use of Canagliflozin

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Statin toxicity developed in a patient taking rosuvastatin and canagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, pointing to the possibility of a drug interaction. The case is reported in the Annals of Internal Medicine.

A woman in her 70s with coronary artery disease, chronic kidney disease, and type 2 diabetes presented with new muscle pain and difficulty walking. She had been taking daily rosuvastatin (40 mg) for 5 years and had started taking canagliflozin (100 mg) 15 days prior. Her lab findings revealed rhabdomyolysis and hepatocellular injury. Her plasma rosuvastatin levels were 15 times higher than what was expected. She improved after rosuvastatin and canagliflozin treatments were stopped.

Cardiology guidelines recommend use of SGLT-2 inhibitors in patients with diabetes and cardiovascular disease. The authors conclude: "On the basis of our experience with this patient, we encourage clinicians to remain vigilant for features of myotoxicity when canagliflozin and rosuvastatin are coprescribed."