Grapefruit-thiazide diuretic interaction

Dr. Kyriacou urges you to reconsider your answer. The presentation and labs fit rhabdomyolysis with acute kidney injury, suggested by severe myalgia, marked creatine kinase elevation, and a rise in creatinine. Hydrochlorothiazide is not significantly metabolized by CYP3A4, which metabolizes grapefruit juice, so grapefruit does not meaningfully raise its levels. If there was inhibition of thiazide metabolism, you would expect electrolyte disturbances, for example hypokalemia, that may produce cramps or weakness. Thiazides do not typically cause marked creatine kinase elevation and myoglobin‑mediated kidney injury. 

Please go back and re-consider. 

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Map: Mattias Garcia_ORU (1096)
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