Disease Information for Statin Myopathy

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Clinical Manifestations
Signs & Symptoms
Cramping in Extremities
Diffuse Aches and Pains
Muscle cramps/spasms
Muscle Pain
Muscle weakness
Myalgias
Proximal limb girdle muscle pain
Proximal muscle weakness
Symmetrical muscle involvement/stiffness
Symmetrical muscle/pain, weakness
Tender or painful muscles/Myalgias
Weakness climbing stairs
Spasms in Both Legs
Weakness/Diffuse motor loss
Dark urine
Constitutional symptoms
Fever
Fever in elderly
Flu-Like Syndrome
High body temperature
Malaise
Non-compliance, medications
Weakness
Weakness/wooziness/standing quickly
Demographics & Risk Factors
Established Disease Population
Patient/Hyperlipidemia
Patient/On Medications long term/ usually
Patient/Arteriosclerotic heart disease
Patient/Hypothyroidism (myxedema)
Patient/Diabetes mellitus
Population Group
Aged Adult
Sex & Age Groups
Population/Adult/all
Population/Elderly Aged
Population/Female
Population/Seventies Adult
Laboratory Tests
Abnormal Lab Findings (Non Measured)
Acute inflammatory markers elevated (Lab)
Transaminase elevation (Lab)
Abnormal Lab Findings - Decreased
Coenzyme Q10 level
Abnormal Lab Findings - Increased
Aspartamine aminotransferase (SGOT, AST) (Lab)
AST (SGOT) (aspartamine transferase) (Lab)
CPK/CK/Creatine kinase/Creatine phosphokinase (Lab)
Creatine, serum (Lab)
Myoglobin
Potassium, serum (Lab)
URINE Myoglobin
Diagnostic Test Results
Pathology
BX/Muscle/Coenzyme Q10 level low
Electrodiagnosis
EMG/Myotonic muscle activity
Associated Diseases & Rule outs
Rule Outs
Dermatomyositis
Eaton-Lambert syndrome
Muscular dystrophy
Myositis, inclusion body
Polymyositis
Associated Disease & Complications
Acute Renal Failure
Colchicine effect/toxicity
Drug induced Myopathy.
Myoglobinemia
Myoglobinuria
Myopathy
Renal Failure Chronic
Rhabdomyolysis
Statin Myopathy
Toxic Myopathy/Poisoning
Disease Synergy - Causes
Synergy/Cyclosporine
Synergy/Fibrates-Gemfibrozil
Synergy/Macrolide antibiotics
Synergy/On medications/medication
Disease Mechanism & Classification
Class
CLASS/Striated muscle disorder (ex)
Drugs
DRUG/Cytochrome CY P450 3A4 degradation pathway
DRUG/P450 metabolic pathway/competitor
Process
PROCESS/Medication/Drug (CONFIRM dose/before treatment)
Synonyms
Synonym
Statin Myopathy, DRUG Toxic drug combination syndrome, DRUG/Combination Gemfibrozil and Statin Risk
Treatment
Drug Therapy - Contraindication
RX/Erythromycin (Erythrocin)
RX/Itraconazole (Sporonox)
RX/Ketoconazole (Nizoral)
Definition

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;-----------

JAMA;2003;289:1681-1690;-----------------

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;

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;

---------------------[Jama 2003 website/google 2006]-------

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)"

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);

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

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

(Edit)

External Links Related to Statin Myopathy
Google
Wikipedia
Merck
Images
PubMed (National Library of Medicine)
NGC (National Guideline Clearinghouse)
Medscape (eMedicine)
Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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