This 48-year-old man with possible underlying myopathy was successfully treated 
with ezetimibe 10 mg/day and rosuvastatin 5 mg every other day for 17 months. 
Three weeks before presentation, he began drinking pomegranate juice (200 ml 
twice weekly). He presented urgently with thigh pain and an elevated serum 
creatine kinase level (138,030 U/L, normal < 200 U/L). In conclusion, because 
both grapefruit and pomegranate juice are known to inhibit intestinal cytochrome 
P450 3A4, this report suggests that pomegranate juice may increase the risk of 
rhabdomyolysis during rosuvastatin treatment, despite the fact that rosuvastatin 
is not known to be metabolized by hepatic P450 3A4.