An Unexpected Cause of Hepatotoxicity and Myopathy in A Patient with Coronary Artery Disease: It Is Not Statin

Abstract

Sertraline is a selective serotonin reuptake inhibitor; it is safe and effective for treating depression in patients with coronary artery disease. Although nausea, diarrhea, and dyspepsia are common adverse effects, less frequent reactions such as maculopathy, hepatotoxicity, and rhabdomyolysis have also been reported. In patients receiving multiple drugs for co-morbid conditions (heart failure, coronary artery disease, etc.), these side effects can be underdiagnosed. Here, we present a patient with coronary artery disease and elevated liver function tests and skeletal muscle enzymes who had multiple admissions and prolonged follow-ups in the emergency room because of elevated creatine kinase and creatine kinase-MB levels, which delayed his appropriate management including discontinuation of sertraline instead of statin.