Natalie Kennie1, Tony Antoniou, Philip Berger. 1. Department of Family and Community Medicine Health Centre, St. Michael's Hospital, Toronto, Ontario, Canada. natalie.kennie@utoronto.ca
Abstract
OBJECTIVE: To report a case of rosiglitazone-associated elevation in creatine kinase (CK) and coexisting myalgias and review other cases identified in the literature. CASE SUMMARY: A 42-year-old man originally from Sri Lanka developed an elevated CK, with peak concentrations of 1671 U/L (normal <160) and myalgias following 5 months of therapy with rosiglitazone. Signs and symptoms recurred upon rechallenge 3 years later. Other potential medical and medication causes were ruled out. Independent assessment by 2 raters using the Naranjo probability scale suggested a probable relationship with rosiglitazone. DISCUSSION: Only 5 previous reports of elevated CK, myalgias, myopathy, or rhabdomolysis in patients taking rosiglitazone or other thiazolidinediones were identified in the literature. Potential risk factors identified from previously published reports included concomitant therapy with fibrates, excessive use of ethanol, and asymptomatic mild CK elevation prior to starting therapy. Based on this case report, it seems reasonable to monitor CK levels in patients on rosiglitazone who are experiencing muscle symptoms or who have a history of myopathy. CONCLUSIONS: Marked elevations of CK and muscle pain may be a possible adverse reaction of rosiglitazone therapy.
OBJECTIVE: To report a case of rosiglitazone-associated elevation in creatine kinase (CK) and coexisting myalgias and review other cases identified in the literature. CASE SUMMARY: A 42-year-old man originally from Sri Lanka developed an elevated CK, with peak concentrations of 1671 U/L (normal <160) and myalgias following 5 months of therapy with rosiglitazone. Signs and symptoms recurred upon rechallenge 3 years later. Other potential medical and medication causes were ruled out. Independent assessment by 2 raters using the Naranjo probability scale suggested a probable relationship with rosiglitazone. DISCUSSION: Only 5 previous reports of elevated CK, myalgias, myopathy, or rhabdomolysis in patients taking rosiglitazone or other thiazolidinediones were identified in the literature. Potential risk factors identified from previously published reports included concomitant therapy with fibrates, excessive use of ethanol, and asymptomatic mild CK elevation prior to starting therapy. Based on this case report, it seems reasonable to monitor CK levels in patients on rosiglitazone who are experiencing muscle symptoms or who have a history of myopathy. CONCLUSIONS: Marked elevations of CK and muscle pain may be a possible adverse reaction of rosiglitazone therapy.