Disclosures: Tommy Ngo, MS: No financial relationships or conflicts of interest

Case Diagnosis: 52 year-old-male admitted with rhabdomyolysis that progressed to bilateral compartment syndrome due to an interaction between his stain and a male supplement.

Case Description or Program Description: A 52-year-old male bodybuilder with a history of hypercholesterolemia presented to the emergency department with bilateral leg swelling and pain. The patient reports having taken a male supplement, Mojo, before working out and noted the lower extremity pain and swelling shortly after his workout. The only medication he had been taking was his statin, Rosuvastatin (Crestor) 40 mg. The patient was sent home after his blood pressure came down. He reported his symptoms were then accompanied by numbness and tingling that had progressively worsened over a couple of hours, which brought him back to the ED.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: The patient was admitted with the diagnosis of rhabdomyolysis that progressed to bilateral compartment syndrome, which required bilateral fasciotomies. He had a wound vac in place and required multiple surgeries for debridement of extensive myopathy. The patient spent 48 days in the hospital and went from total assistance to being able to walk independently after a week of inpatient.

Discussion (relevance): This case seemed to be a rare drug interaction between statins and this male enhancement drug. The male enhancement drug contains the active ingredient Epimedium. Epimedium is a CYP450 inhibitor, which may have caused an increased concentration of his statin. This may have led to the patient’s rhabdomyolysis exacerbated by the increased metabolic demand to his legs during the workout. Further, the ingredients Epimedium along with Yohimbine in the supplement likely caused increased blood flow to the legs leading to reperfusion injury, and thus, compartment syndrome.

Conclusions: Traditionally, over-the-counter supplements are thought to be low risk, this case illustrates how these substances, which are not regulated by the FDA, can be very dangerous when combined with commonly prescribed medications.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-adverse-effects-of-statins-when-mixed-with-an-over-the-counter-male-enhancement-drug-a-case-report/