A 63-year-old woman previously stable on a regimen of atorvastatin 40 mg daily, 
carvedilol 25 mg twice daily, digoxin 0.125 mg daily, furosemide 40 mg daily, 
spironolactone 25 mg daily, rivaroxaban 15 mg daily, and enalapril 20 mg twice 
daily for heart failure developed rhabdomyolysis 26 days after enalapril was 
stopped and sacubitril/valsartan (Entresto™) started. The patient received 
sacubitril/valsartan at 24/26 mg twice daily for heart failure; however, after 
26 days she developed muscle and skin pain. Investigations revealed elevated 
creatine kinase and liver function tests, and rhabdomyolysis with raised 
transaminases was diagnosed. Sacubitril/valsartan and atorvastatin were 
discontinued and the patient was hydrated. She returned to baseline in 23 days 
and has not had any reoccurrence of rhabdomyolysis and elevated transaminases 
for 46 days. A Naranjo assessment score of 5 was obtained, indicating a probable 
relationship between the patient's rhabdomyolysis and her use of 
sacubitril/valsartan. The Drug Interaction Probability Scale score was 3, 
consistent with a possible interaction as a cause for the reaction, with 
sacubitril/valsartan as the precipitant drug and atorvastatin as the object 
drug.