Rhabdomyolysis as a Side Effect of the Drug Interaction between Atorvastatin and Sacubitril/Valsartan
Bibliographic record
Abstract
Sacubitril/valsartan is an increasingly used medication in patients with severe left ventricular dysfunction. Here, we present an 83-year-old male with an ejection fraction of 18% who presented with rhabdomyolysis shortly after initiation of this medication in the setting of being on atorvastatin safely for many years previously. Interestingly, prior pharmacological studies have demonstrated an interaction between sacubitril and atorvastatin via the OATP pathway. In particular, sacubitril has been shown to inhibit OATP1B1 and 1B3, the rate-limiting step for the elimination of atorvastatin, which can result in the drug’s accumulation. This phenomenon was determined to be the most likely etiology behind the patient’s rhabdomyolysis in this case. Once the medications were discontinued, the rhabdomyolysis resolved. If both a statin and sacubitril/valsartan need to be co-administered, starting the statin at a low dose with careful monitoring of symptoms, CK, electrolytes, and creatinine during gradual titration should be considered.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".