Disease Information for Statin Myopathy (Clinical Manifestations)

Statin Myopathy

drug induced myopathy usually rhabdomyolysis but also just weakness with high cpk and urine myoglobin minimal; worst drug was baycol now off the market as toxic; more common as drug is so commonly used, at least in USA; triggered with Fibrates, cyclosporin or macrolide antibiotics; proximal limb girdle weakness and myalgias usually;-----------<br>

JAMA;2003;289:1681-1690;-----------------<br>

Statin-Associated Myopathy ;Paul D;Thompson, MD; Priscilla Clarkson, PhD; Richard H;Karas, MD, PhD Statins are associated with skeletal muscle complaints, including clinically important myositis and rhabdomyolysis, mild serum creatine kinase (CK) elevations, myalgia with and without elevated CK levels, muscle weakness, muscle cramps, and persistent myalgia and CK elevations even after statin withdrawal; ;Adverse event reports of statin-associated rhabdomyolysis were also collected from the FDA MEDWATCH database;<br>

Few data are available regarding the frequency of less-serious events such as muscle pain and weakness, which may affect 1% to 5% of patients;The risk of rhabdomyolysis and other adverse effects with statin use can be exacerbated by several factors, including compromised hepatic and renal function, hypothyroidism, diabetes, and concomitant medications; Medications such as the fibrate gemfibrozil alter statin metabolism and increase statin plasma concentration; How statins injure skeletal muscle is not clear, although recent evidence suggests that statins reduce the production of small regulatory proteins that are important for myocyte maintenance;<br>

---------------------[Jama 2003 website/google 2006]-------<br>

Also many patients complain of myalgia when on treatment with statins with this side effect having an incidence of up to 5%; Myositits; mild myositis is associated with painful muscles and CK elevation;Some suggest withdrawal of statin therapy is indicated in patients whose CK rises 10-fold to levels about 2,000 IU/L (1) whilst others suggest that "patients experiencing muscle pain, weakness or cramps whilst should have their CK level measured;If this is significantly elevated (>5x upper limit of normal) or if myopathy is suspected, treatment should be stopped (2)" <br>

rhabdomyolysis (characterised by plasma CK > 20,000 IU/L, myoglobinuria and extreme muscular pain) occurs in about 1 in 250,000 patients and is commoner in females, the elderly, hypothyroidism and with concomitant therapy with cytochrome P450 3A4 metabolised drugs eg cyclosporin, erythromycin, and fibrates (particularly gemfibrozil); <br>

Myalgia: far commoner than myositis and is not accompanied by any rise in CK levels; the mechanism is obscure <br>

--------------------[gpnotebook website UK 2006]---------

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