Rhabdomyolysis after Ginkgo biloba and cannabis

Abstract

Background: Rhabdomyolysis is a syndrome caused by the death of muscle tissue, which leads to the release of the muscle protein myoglobin into the circulation. The severity of rhabdomyolysis varies widely from asymptomatic to life threatening, and has many possible causes, including a specific classification associated with medications. This report suggests the potential for rhabdomyolysis induction by an interaction between ginkgo (Ginkgo biloba) and cannabis, in addition to recent strenuous exercise. Prompt identification of the aetiology and treatment are crucial in preventing complications and mortality. Clinical details: A 26-year-old African American female presented to the emergency department (ED) with a chief complaint of worsening muscle pain and weakness, 2 days after exercise without adequate hydration. The patient reported recently starting a ginkgo supplement, in addition to her regular medications and confirmed marijuana use. Urinalysis and creatine kinase (CK) data collected in the ED were suggestive of rhabdomyolysis. Outcomes: The patient was admitted to hospital. After rehydration with intravenous normal saline, her CK levels and symptoms improved. Conclusion: Ginkgo is an increasingly popular natural supplement with a variety of uses. However, the use of this product, with or without cannabis consumption, may correspond to an increased likelihood for interactions and adverse drug reactions, such as the potential for rhabdomyolysis presented here. It is important for pharmacists and other clinicians to be aware of the prospective risks associated with this supplement in order to properly educate patients and mitigate potential morbidities.