Rhabdomyolysis Caused by Commiphora mukul, a Natural Lipid-Lowering Agent - Toxicity Limits

Rhabdomyolysis Caused by Commiphora mukul, a Natural Lipid-Lowering Agent
Jul 2004
Antonio Bianchi, Paola Cant?, Fabio Firenzuoli, Gabriela Mazzanti, Francesca Menniti-Ippolito, and Roberto Raschetti
The Annals of Pharmacotherapy
Abstract
OBJECTIVE: To report a case of rhabdomyolysis caused by Commiphora mukul, a natural lipid-lowering agent.
CASE SUMMARY: A 55-year-old man was taking an extract of C. mukul 300 mg 3 times daily to lower his cholesterol level. He developed rhabdomyolysis with hemoglobinuria after 2 weeks of treatment. Laboratory tests showed creatine kinase 144 600 IU/L (reference range 24?195), myoglobin >3000 ng/mL (28?72), lactate dehydrogenase 7157 IU/L (230?460), aspartate aminotransferase 1115 IU/L (10?35), and alanine aminotransferase 205 IU/L (10?35). Analysis of a urine sample was 2+ positive for hemoglobin. All parameters returned to normal after the herbal preparation was discontinued.
DISCUSSION: The Naranjo probability scale indicates C. mukul as the possible cause of rhabdomyolysis in our patient. Drug-induced rhabdomyolysis is an established but rare adverse effect of high doses of cholesterol-lowering agents (statins) or interactions between drugs (eg, statins and fibrates). As of May 28, 2004, to our knowledge, this is the first reported case of rhabdomyolysis following C. mukul ingestion.
CONCLUSIONS: Our report describes a case of rhabdomyolysis possibly caused by C. mukul and underlines the need for active surveillance of natural products.
Key Words: Commiphora mukul, guggul, herbal supplements, rhabdomyolysis
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