Livazeb medication should be cautious of the risk of rhabdomyolysis, a serious adverse reaction that can lead to renal failure or even death. The following provides a detailed explanation of precautions in terms of monitoring indicators, risk populations, symptom identification, and treatment measures.

1. High risk population screening

(1) Elderly patients (≥ 65 years old) have a 2.4-fold increased risk of myopathy.

(2) Patients with renal insufficiency (eGFR<60ml/min) have a reduced drug clearance rate.

(3) Combination use of statin/beta lipid-lowering drugs in patients.

(4) Uncontrolled hypothyroidism.

2. Baseline assessment before medication

(1) Must check creatine kinase (CK): If the baseline value is>5 times ULN, medication should be temporarily suspended.

(2) Liver and kidney function: ALT/AST ≤ 3 times ULN, Scr ≤ 1.5 times UL.

(3) Electrolytes: correct hypokalemia/hypomagnesemia.

(4) Combination medication review: Avoid using strong CYP3A4 inhibitors in combination.

3. Monitoring during treatment

(1) CK monitoring: once a week in the first month and once a month thereafter.

(2) Creatinine monitoring: Test immediately when muscle pain occurs.

(3) Urine volume observation: maintain>1500ml/day.

(4) Symptom inquiry: Focus on skeletal muscle pain/weakness.

4. Identification of rhabdomyolysis

(1) Typical symptoms: muscle pain/tenderness, brownish urine, and general fatigue.

(2) Laboratory standard: CK>1000U/L with elevated creatinine.

(3) Critical value: CK>5000U/L or blood potassium>6mmol/L.

5. Emergency response process

(1) Immediately discontinue medication and seek hospitalization for treatment.

(2) Intravenous hydration: physiological saline 200-300ml/h.

(3) Alkalinization of urine: Sodium bicarbonate maintains urine pH>7.0.

(4) Blood purification: Consider continuous CK>10000U/L.

6. Principle of Restarting Medication

(1) CK restored to<2 times ULN.

(2) Stable renal function (Scr fluctuation<20%).

(3) Reduce usage by 50%.

(4) Strengthen monitoring to CK twice a week.