An Unexpected Cause of Hepatotoxicity and Myopathy in A Patient with Coronary Artery Disease: It Is Not Statin

Abstract

Sertraline is a selective serotonin reuptake inhibitor; it is safe and effective for treating depression in patients with coronary artery disease. Although nausea, diarrhea, and dyspepsia are common adverse effects, less frequent reactions such as maculopathy, hepatotoxicity, and rhabdomyolysis have also been reported. In patients receiving multiple drugs for co-morbid conditions (heart failure, coronary artery disease, etc.), these side effects can be underdiagnosed. Here, we present a patient with coronary artery disease and elevated liver function tests and skeletal muscle enzymes who had multiple admissions and prolonged follow-ups in the emergency room because of elevated creatine kinase and creatine kinase-MB levels, which delayed his appropriate management including discontinuation of sertraline instead of statin.

Keywords

• Coronary artery disease,hepatotoxicity,myopathy,sertraline

Koroner Arter Hastalığı Olan Bir Hastada Beklenmedik Bir Hepatotoksisite ve Miyopati Nedeni: Statin Değil

Abstract

Sertralin koroner arter hastalığına eşlik eden depresyon durumlarında etkinliğini ve güvenirliliğini kanıtlamış bir selektif serotonin geri alım inhibitörüdür. Sık görülen yan etkileri yanında (bulantı, ishal, dispepsi) daha nadir görülen (makülopati, hepatotoksisite, rabdomiyoliz) gibi yan etkileri de bildirilmiştir. Çoklu ilaç kullanımının sık olduğu hastalarda (kalp yetersizliği, koroner arter hastalığı gibi) depresyon tedavisinde sertralin kullanımına bağlı yan etkiler gözden kaçabilmektedir. Biz karaciğer fonksiyon testleri ve kas enzimleri yükselmiş bir koroner arter hastasında sertralinin; statinlerden sonra etyolojik ajan olarak değerlendirildiği ve bu sürede kreatinin kinaz, kreatinin kinaz-MB yüksekliği nedeniyle uzamış acil servis takipleri olan bir olguyu sunuyoruz.

Keywords

• Koroner arter hastalığı,hepatotoksisite,miyopati,sertralin

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