Virginia Via Research Day Book 2026

Medical Student Research Case Reports

41 MARIJUANA AS A POTENTIAL TRIGGER OF STATIN-INDUCED RHABDOMYOLYSIS

Raymond Toncich, OMS-III; Dr. Gretchen Junko, DO Corresponding author: rtoncich@vcom.edu VCOM-Virginia, Blacksburg, Virginia LewisGale Medicial Center - HCA VA Health System Rhabdomyolysis is a well-known clinical syndrome due to the acute breakdown of skeletal muscle, leading to the release of intracellular muscle components, which can ultimately progress to systemic complications if not treated in a timely manner. Some of these complications include acute kidney injury (AKI), electrolyte disturbances, and disseminated intravascular coagulation. The clinical presentation of this syndrome is a classic triad of muscle pain or weakness, dark tea colored urine (due to elevated myoglobin), and serum creatinine kinase (CK) levels 5 times the upper limit of normal. Management includes treatment of underlying etiologies and prevention of systemic complications, primarily by fluid resuscitation. Determining the incidence of the syndrome is difficult because many mild cases go undocumented or aren’t recognized by patients. In the past, it had been reported that in the United States, approximately 26,000 cases of Rhabdomyolysis were hospitalized every year. The etiology of Rhabdomyolysis is extensive, with traumatic injury and overexertion being the most common causes,

followed by drug toxicity, infection, and metabolic disorders. The patient in our case is a 63-year-old female with prior medical history of congestive heart failure, COVID-19, hyperlipidemia, chronic kidney disease stage 4 (CKD4), vitamin D deficiency, seasonal allergies, and two prior myocardial infarctions (MI) (at the ages of 32 and 36) who presented to our emergency department (ED) for generalized weakness particularly in her lower extremities. Notable history shows that she recently introduced marijuana to her routine due to having a decreased appetite and long-term Statin therapy (Rosuvastatin). Initial laboratory values, including elevated CK and myoglobin, established a diagnosis of Rhabdomyolysis. Statins are widely prescribed for patients with atherosclerotic cardiovascular disease for their lipid-lowering effects; they are also a rare cause of Rhabdomyolysis. Some specific risk factors associated with Statin-induced Rhabdomyolysis include female

gender, advanced age, small body frame and frailty, chronic kidney disease, hepatic insufficiency, physical disability, perioperative period, and multiple concomitant drug use. Rosuvastatin, unlike other Statins, is primarily excreted in the feces (90%), with minimal metabolism by cytochrome P450 enzymes in the liver; CYP2C9 has the most contribution. In our case, common drug interactions were eliminated as a potential cause, along with CKD due to Rosuvastatin's lack of renal involvement. After the patient started using marijuana, there was concern about how this new addition might interact with their medications. Recent studies show that certain compounds in cannabis, especially cannabidiol (CBD), can slow down the enzymes CYP2C19 and CYP2C9, which help the body process Statins. Even though we don’t have a lot of clear proof about how Statins and marijuana interact, this could help explain why some people taking statins end up with muscle problems like Rhabdomyolysis after using cannabis. With marijuana

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2026 Research Recognition Day