A 62-year-old male with medical records of hypertension, myocardial infarction, chronic renal failure, renal anemia, dyslipidemia, and alcoholic liver disease. The patient had been diagnosed with CKD at the Department of Nephrology, and treated by outpatient care with renal support therapy for the past two years. On X-63 day, his prescription was rosuvastatin (10 mg/day) and a continuous erythrocyte-stimulating agent, epoetin beta pegol [7] (genetical recombination, 100 μg). Blood tests revealed SCr 3.75 mg/dL, Hb 9.5 g/dL, high density lipoprotein cholesterol (HDL-c) 69 mg/dL, and low density lipoprotein cholesterol (LDL-c) 21 mg/dL. X-day 0, blood tests revealed CPK 298 U/L, SCr 5.26 mg/dL, Hb 9.5 g/dL, HDL-c 62 mg/dL, and LDL-c 16 mg/dL, so the prescription was changed from epoetin beta pegol 100 μg to vadadustat 300 mg/day. On X + day 80, a prescription for a diuretic (azosemide [8] 15 mg/day) was added for swelling of the lower extremities. Muscle pain in both legs appeared on around X + 80 day. Furthermore, at the time of admission, the patient had persistent muscle pain in both legs, further muscle weakness, and increase of CPK level. Reddish-brown urine, possibly myoglobinuria, was also observed. Therefor the patient was diagnosis as rhabdomyolysis.

On X + day 105 at his regular clinic visit, blood tests showed CPK 16,509 U/L, SCr 6.51 mg/dL, Hb 9.5 g/dL, HDL-c 33 mg/dL, and LDL-c 16 mg/dL. The patient was diagnosed with rhabdomyolysis and hospitalized. On admission, the pharmacist suggested to the doctor that the discontinuation of vadadustat and rosuvastatin to the physician as a possible cause of the elevated CPK levels due to drug interactions. As a result, both drugs were discontinued and the patient was administered intravenous fluids. Thereafter, CPK and SCr values improved. The pharmacist suggested to the doctor epoetin beta pegol, which had been previously administered for renal anemia, since the CPK level had decreased. Furthermore, the doctor asked the pharmacist to resume rosuvastatin because of ischemic heart disease. The pharmacist informed the doctor that statins alone have few side effects such as rhabdomyolysis [9], and the drug was resumed in small doses in consideration of safety.

On X + day 122, CPK improved to 29 U/L, SCr 2.6 mg/dL, and Hb 9.6 g/dL, and he was discharged on X + day 124. At discharge, rosuvastatin 2.5 mg/day was resumed. A blood test on X + day 133 showed CPK 144 U/L SCr 4.22 mg/dL, Hb 8.9 g/dL, HDL-c 57 mg/dL, and LDL-c 64 mg/dL (Fig. 1).