The Annals of Pharmacotherapy: Vol. 39, No. 1, pp. 146-149. DOI 10.1345/aph.1E285

© 2005 Harvey Whitney Books Company.

Acute Rhabdomyolysis Associated with Ofloxacin/Levofloxacin Therapy

Shu-Hwa Hsiao, BSc (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital, Taiwan, Republic of China

Chia-Ming Chang, MD

Clinical Specialist in Infection, National Cheng Kung University Hospital

Chao-Jung Tsao, MD PhD

Professor of Internal Medicine, College of Medicine, National Cheng Kung University

Yu-Yun J Lee, MD PhD

Professor of Dermatology, College of Medicine, National Cheng Kung University

May-Ying Hsu, MSc (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital

Ta-Jen Wu, MD

Associate Professor of Internal Medicine, College of Medicine, National Cheng Kung University

OBJECTIVE: To report a case of ofloxacin/levofloxacin-induced rhabdomyolysis and to compare other reported cases from the literature.

CASE SUMMARY: A 19-year-old male patient developed ofloxacin/levofloxacin-induced rhabdomyolysis during admission for periorbital cellulitis. Symptoms of myalgia, weakness, and swelling of the arms developed after 3 days of treatment with ofloxacin 800 mg/day. Laboratory analysis confirmed the presence of urine myoglobin (381.2 µg/L) and a marked increase in serum myoglobin (590.8 µg/L), along with marked elevations in serum creatine kinase (up to 16 546 IU/L).

DISCUSSION: In addition to ruling out other possible etiologic factors one by one, we assessed the probability of ofloxacin/levofloxacin-induced rhabdomyolysis by observing the close time relationship between drug administration and the development of symptoms/signs, as well as the close time relationship between drug withdrawal and the disappearance of symptoms/signs. An objective causality assessment by use of the Naranjo probability scale revealed that the adverse drug reaction was probable.

CONCLUSIONS: Although ofloxacin/levofloxacin-induced rhabdomyolysis appears to be rare, patients with muscle pain, swelling, or weakness during therapy should be closely monitored for this adverse effect.

Published online, November 23, 2004. www.theannals.com, DOI 10.1345/aph.1E285