Rosuvastatin coprescription with canagliflozin tied to Statin toxicity

Rosuvastatin is a commonly prescribed statin and canagliflozin is one of a newer class of diabetes drugs, the sodium-glucose cotransporter-2 (SGLT2) inhibitors. It is common for patients with diabetes to also take a statin. In fact, the American College of Cardiology currently recommends adding an SGLT2 inhibitor, such as canagliflozin, to the regimens of patients with diabetes and cardiovascular disease.

Researchers from the University of Toronto describe the case of a patient who was hospitalized with severe rosuvastatin toxicity (manifesting as muscle damage and inability to walk) 2 weeks after starting canagliflozin. Although she had taken rosuvastatin uneventfully for more than 5 years, her blood rosuvastatin concentration when she arrived at the hospital was 15 times higher than expected for her dose. The authors speculate that canagliflozin caused rosuvastatin toxicity by increasing rosuvastatin absorption, and by reducing its elimination by the liver and kidney. The authors encourage clinicians to remain vigilant for features of myotoxicity when canagliflozin and rosuvastatin are co-prescribed.