Statins and Myopathy
Thompson PD, Clarkson P, Karas RH: Statin associated myopathy. JAMA 2003,283(13):1681-1630.
Recent evidence suggests HMG-CoA reductase inhibitors (statins) may injure skeletal muscle by reducing the production of small regulatory proteins that are important for myocyte maintenance.
Statins have been associated with clinically important myositis and rhabdomyolysis, mild serum creatine kinase (CK) elevations, myalgia with and without elevated CK levels, and muscle weakness and cramps. The authors review the literature and make recommendations for clinical evaluation and management.
The most serious risk, rhabdomyolysis, is extremely rare, but less-severe muscle complaints may affect 1%-5% of patients.
Hypothyroidism, diabetes, and compromised renal and hepatic function, as well as concomitant medications, can increase the risk of rhabdomyolysis and other adverse effects.
The authors state that there is no absolute contraindication to combining a statin with an agent known to increase the risk of myopathy (eg. fibrates, niacin, verapamil, HIV protease inhibitors, macrolide antibiotics, amiodarone, and others) if the benefits are likely to outweigh the risks.
In this case, the patient must also understand the risks and be willing to promptly report any untoward reactions.
Although the authors don't routinely monitor CK levels, they start CK monitoring in asymptomatic patients if the CK is somehow detected to be >5 times the upper limit of normal. The statin is stopped if CK is elevated to >10 times the upper limit of normal.
Patients complaining of myalgias without elevated CK levels can continue the medication if their symptoms are tolerable.
Copyright Springhouse Corporation Jun 2003
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