J Clin Lipidol. 2026 Oct 4:S1933-2874(26)00541-6. doi: 10.1016/j.jacl.2026.09.025. Online ahead of print.
ABSTRACT
Statins are among the most common causes of medication-associated rhabdomyolysis. Abiraterone, an oral androgen biosynthesis inhibitor, has been reported to increase the risk of statin-associated muscle toxicity through inhibition of hepatic transporters involved in statin disposition, potentially increasing systemic statin exposure. Despite this proposed mechanism, direct pharmacokinetic evidence of this interaction in patients experiencing this adverse event has not previously been reported. We report a case of rhabdomyolysis complicated by acute kidney injury (AKI) in a patient on long-term rosuvastatin therapy following initiation of abiraterone for the treatment of prostate cancer. Quantitative plasma analysis using liquid chromatography-mass spectrometry demonstrated a rosuvastatin concentration substantially higher than concentrations observed with therapeutic dosing and consistent with previously reported toxic concentrations. This case provides pharmacokinetic support for a clinically significant abiraterone-rosuvastatin drug interaction and underscores the importance of medication review, early recognition of muscle toxicity, and consideration of alternative lipid-lowering strategies to preserve atherosclerotic cardiovascular disease (ASCVD) risk reduction in patients being treated with abiraterone. To our knowledge, this is the first reported case demonstrating markedly elevated plasma rosuvastatin concentrations in the setting of abiraterone-associated rhabdomyolysis.
PMID:42892604 | DOI:10.1016/j.jacl.2026.09.025