1.
Fenofibrate monotherapy-induced rhabdomyolysis in a patient with hypothyroidism: A rare case report and literature review.
Wang, D, Wang, Y
Medicine. 2018;(14):e0318
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Abstract
RATIONALE Fenofibrate is a fibric acid derivative indicated for use in hypertriglyceridemia and mixed dyslipidemia treatment among adults. Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation, which is the most serious and fatal side effect of fenofibrate. The objective of this paper is to discuss fatal side effect of fenofibrate and keep safe medication. PATIENT CONCERNS A patient with hypothyroidism who presented with rhabdomyolysis during fenofibrate monotherapy for hypertriglyceridemia was reported. DIAGNOSES Fenofibrate Monotherapy Induced Rhabdomyolysis. INTERVENTIONS Fenofibrate was stopped. Adequate fluid resuscitation, mannitol diuresis, myocardium protection, hepatoprotection and urine alkalinization with sodium bicarbonate were performed. OUTCOMES Blood tests were normal and the patient was good and discharged 2 weeks later. LESSONS 13 cases associated with fenofibrate monotherapy-induced rhabdomyolysis were reviewed, which had been published in the English literature. The severity of fenofibrate muscle toxicity may be the result of the combination of two rhabdomyolysis enhancers, such as hypothyroidism and female gender. To avoid it, strict clinical and laboratory monitoring should be maintained, particularly hypothyroidism. Patients should be informed of possible potentially irreversible effects after taking fibrates.
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Managing diabetes in the middle-aged patient when loss of glycemic control occurs.
Peters, A
The Diabetes educator. 2012;(4 Suppl):13S-21S; quiz 22S
Abstract
PURPOSE The purpose of this article is to review the treatment of a patient with type 2 diabetes who is commonly seen in practice-specifically, a middle-aged obese patient with micro- and macrovascular complications whose A1C rises after therapeutic intervention. Discussion of glucose management, as well as hypertension, dyslipidemia, and obesity comorbidities, is included. CONCLUSION The key to successful treatment is individualization of targets and therapeutic choices. GLP-1 receptor agonists have been shown to be effective in the treatment of type 2 diabetes, including aiding with A1C reduction and weight loss. Using a combination of old and new treatments for the management of diabetes can help to improve outcomes.
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A multimodal, evidence-based approach to achieve lipid targets in the treatment of antiretroviral-associated dyslipidemia: case report and review of the literature.
Bain, AM, White, EA, Rutherford, WS, Rahman, AP, Busti, AJ
Pharmacotherapy. 2008;(7):932-8
Abstract
Metabolic abnormalities associated with the treatment of human immunodeficiency virus (HIV) infection are well-recognized problems that increase cardiovascular risk. As a result of the complexity of treating both HIV- and antiretroviral-related comorbidities, strategies that improve adverse drug events while maintaining viral control are in critical need. Although guidelines have somewhat helped in the general approach and in first-line strategies for managing dyslipidemia in patients receiving antiretrovirals, a paucity of data exist to guide clinicians in treating patients whose conditions are refractory to first-line options or who are at substantial risk for cardiovascular events. Further complicating the choice of lipid-lowering strategy is the lack of randomized controlled data from the HIV-affected population and a concern about clinically significant drug-drug interactions. We describe an HIV-infected patient with efavirenz-associated dyslipidemia at very high cardiovascular risk who had not achieved his primary or secondary lipid goals despite 2 years of treatment in a lipid specialty clinic. Lipid control was accomplished in 10 weeks with a targeted, stepwise approach of switching efavirenz to nevirapine, followed by rosuvastatin 20 mg/day, which was sustained for at least 10 months. Of most importance, this outcome was achieved without any clinically significant alteration in virologic or immunologic control. This case report highlights the potential for a pharmacist-guided, multistep approach that addresses HIV-related dyslipidemia and incorporates the pharmacokinetic literature to guide lipid-lowering therapy and promote the attainment of goals based on current standards of care.