Alcohol-associated rhabdomyolysis: ethanol induction of cytochrome P450 may potentiate myotoxicity.

An association between alcohol use and episodes of rhabdomyolysis has long been recognized, but never understood. Ethanol is a potent inducer of cytochrome P450. In the presence of cytochrome P450, the metabolism of many drugs includes reactive and toxic intermediates. Accordingly, some alcohol-associated myotoxicity could be related to skeletal muscle cytochrome P450 induction by ethanol leading to the production of toxic metabolites of other compounds that then injure muscle. The recent identification and localization of cytochrome P450 on skeletal muscle sarcoplasmic reticulum provides supportive evidence for this potential role of ethanol in the pathogenesis of alcohol-associated rhabdomyolysis. Case histories of episodes of rhabdomyolysis in individuals with chronic ethanol abuse characteristically do not comment on the concomitant consumption of other substances. This common deficiency is illustrated by two additional case histories of alcohol-associated rhabdomyolysis.