From the Guidelines
Rosuvastatin overdose is a medical emergency that requires immediate attention, and treatment should focus on supportive care, including monitoring liver and kidney function, checking creatine kinase levels, and providing intravenous fluids. The effects of an overdose of rosuvastatin can be severe and may include muscle pain, weakness, kidney problems, and liver dysfunction 1. There is no specific antidote for rosuvastatin overdose, and hemodialysis is not effective in removing the drug from the body due to its high protein binding 1.
Key considerations in managing rosuvastatin overdose include:
- Monitoring liver and kidney function to assess for potential damage
- Checking creatine kinase levels to evaluate muscle damage
- Providing intravenous fluids to support hydration and renal output
- Considering the use of activated charcoal if the overdose was recent to reduce absorption
- Being aware of potential drug-drug interactions, especially with immunosuppressants, which can increase the risk of muscle-related toxicity 1
It is crucial to prioritize prevention by taking rosuvastatin exactly as prescribed, keeping it out of reach of children, and never taking extra doses to "catch up" if a dose is missed. In the event of an overdose, calling poison control (1-800-222-1222) or going to the emergency room right away is essential. The most recent guidelines, such as those from the American Heart Association and American College of Cardiology 1, emphasize the importance of careful management and monitoring in patients taking statins, including rosuvastatin, to minimize the risk of adverse effects.
From the FDA Drug Label
In case of an overdose, get medical help or contact a live Poison Center expert right away at 1-800-222-1222. The effects of an overdose of rosuvastatin are not explicitly described in the drug label. Key points:
- The label advises to get medical help or contact a Poison Center expert in case of an overdose.
- It does not provide information on the specific effects of an overdose. 2
From the Research
Effects of Rosuvastatin Overdose
The effects of an overdose of rosuvastatin, a statin medication, can be severe and include:
- Rhabdomyolysis, a condition characterized by the breakdown of muscle tissue, leading to acute kidney injury and other complications 3, 4, 5
- Elevated serum creatine kinase concentration, indicating muscle damage 3, 4, 5
- Acute kidney injury, which may require haemodialysis 3, 4
- Myalgia, or muscle pain, and weakness 4, 5
- Increased risk of renal toxicity, particularly in patients with pre-existing kidney disease 6
Risk Factors for Rosuvastatin-Induced Rhabdomyolysis
Certain factors can increase the risk of developing rhabdomyolysis due to rosuvastatin overdose, including:
- High doses of rosuvastatin, particularly above 40 mg/day 4, 7
- Medication errors, such as taking multiple rosuvastatin-containing preparations simultaneously 4
- Pre-existing kidney disease, particularly stage IV chronic kidney disease 6
- Certain genetic factors, such as the CYP2C9*1/*3 genotype 4
- Concomitant use of other medications, such as warfarin 4
Clinical Presentation and Management
Patients presenting with rosuvastatin-induced rhabdomyolysis may exhibit symptoms such as:
- Progressive asthenia and diffuse myalgia 4
- Generalized muscle pain, weakness, and easy fatigability 5
- Dark urine, indicating myoglobinuria 5 Management of rosuvastatin-induced rhabdomyolysis typically involves:
- Immediate withdrawal of rosuvastatin 3, 4, 5
- Intravenous fluid administration and monitoring of serum electrolytes 5
- Haemodialysis, if necessary, to manage acute kidney injury 3, 4