Acute Rhabdomyolysis and Hemoglobin Reduction after Bezafibrate Overdose in Hyperlipidemic Patients on Hemodialysis

Dr. Pier Luigi Bedani, Division of Nephrology, S. Anna Hospital, Corso Giovecca 203, I-44100 Ferrara (Italy) Dear Sir, Many patients with chronic renal failure (CRF) develop hyperlipidemia. Frequently, to correct this abnormality some form of pharmacological intervention is necessary. In clinical trials bezafibrate was administered to hyperlipidemic patients with CRF [1] or in regular dialytic treatment (RDT) [2]. Severe adverse reactions were reported infrequently but in some patients suffering from CRF [3] bezafibrate therapy induced rhabdomyolysis. We present 2 cases of bezafibrate overdose complicated with rhabdomyolysis and acute hemoglobin reduction in patients on RDT. Case 1: A 63-year-old man on RDT for 5 months owing to diabetic nephropathy was treated with bezafibrate at the dosage of 400 mg every second day. Four weeks later he experienced diffuse muscle weakness and nocturnal cramps. Laboratory studies showed a slight increase in serum creatine phosphokinase (CPK) and lactic dehydroge-nase (LDH) with a small reduction in Hb concentration (from 8.1 to 7.4 g/dl). Because of the persistence of hypertriglyceridemia, we recommended that the patient continue the bezafibrate therapy with a more appropriate dosage (i.e. 200 mg every third day). The erroneous understanding of our prescription made the patient carry on with the same dosage of the drug. After a further 4 weeks he experienced aching of his muscles, which gradually worsened, leading to generalized weakness and severe fatigue in walking. The most significant laboratory data are shown in figure 1. There was also a light increase of serum and urine concentrations of myoglobin without reduction of daily diuresis. The drug