Statin induced myopathy history and symptoms: Difference between revisions
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===History=== | ===History=== | ||
*The patients usually complain of muscle pain or weakness that: | *The patients usually complain of muscle pain or weakness that: | ||
** | ** is located in large, symmetric, proximal muscle groups | ||
** | ** gets exacerbated by exercise | ||
** | ** gets better within 2 weeks of withholding [[statins]] | ||
** | ** recurs within 2 weeks of restarting [[statins]]<ref name="pmid21632911">{{cite journal| author=Fernandez G, Spatz ES, Jablecki C, Phillips PS| title=Statin myopathy: a common dilemma not reflected in clinical trials. | journal=Cleve Clin J Med | year= 2011 | volume= 78 | issue= 6 | pages= 393-403 | pmid=21632911 | doi=10.3949/ccjm.78a.10073 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21632911 }} </ref> | ||
* It is important that the history of the patient includes the list of | * It is important that the history of the patient includes the list of current medications, mainly any of the following: | ||
**[[CYP450 | **[[CYP450]] inhibitors: examples of CYP450 inhibitors are azole [[antifungals]] ([[itraconazole]], [[ketoconazole]], [[fluconazole]]), [[macrolide]] antibiotics ([[erythromycin]], [[clarithromycin]]), [[protease inhibitors]] ( ritonavir, nelfinavir, indinavir). | ||
** [[Fibrates]]: the combination of | ** [[Fibrates]]: the combination of [[statins]] with [[fibrates]] is beneficial in the case of [[metabolic syndrome]] or [[diabetic dyslipidemia]]; however, [[fibrates]] increases the risk of statin induced myopathy.<ref name="pmid20628837">{{cite journal| author=Harper CR, Jacobson TA| title=Evidence-based management of statin myopathy. | journal=Curr Atheroscler Rep | year= 2010 | volume= 12 | issue= 5 | pages= 322-30 | pmid=20628837 | doi=10.1007/s11883-010-0120-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20628837 }} </ref> | ||
* The patient should be asked about any history of excessive exercise or trauma.<ref name="pmid20628837">{{cite journal| author=Harper CR, Jacobson TA| title=Evidence-based management of statin myopathy. | journal=Curr Atheroscler Rep | year= 2010 | volume= 12 | issue= 5 | pages= 322-30 | pmid=20628837 | doi=10.1007/s11883-010-0120-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20628837 }} </ref> | * The patient should be asked about any history of excessive exercise or trauma.<ref name="pmid20628837">{{cite journal| author=Harper CR, Jacobson TA| title=Evidence-based management of statin myopathy. | journal=Curr Atheroscler Rep | year= 2010 | volume= 12 | issue= 5 | pages= 322-30 | pmid=20628837 | doi=10.1007/s11883-010-0120-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20628837 }} </ref> | ||
Latest revision as of 21:00, 1 December 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby
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Overview
The symptoms of statin induced myopathy belong to a spectrum ranging from being mild and asymptomatic to severe and lethal. The time of onset of symptoms varies among people, but the median of onset of symptoms is four weeks since the beginning of the treatment. Similarly, the time for the resolution of symptoms after appropriate management also varies among individuals.[1]The history of the patient provides a description about the characteristic of the muscle pain as well as details about medications, history of trauma, exercise or excessive alcohol use.
History and Symptoms
History
- The patients usually complain of muscle pain or weakness that:
- It is important that the history of the patient includes the list of current medications, mainly any of the following:
- CYP450 inhibitors: examples of CYP450 inhibitors are azole antifungals (itraconazole, ketoconazole, fluconazole), macrolide antibiotics (erythromycin, clarithromycin), protease inhibitors ( ritonavir, nelfinavir, indinavir).
- Fibrates: the combination of statins with fibrates is beneficial in the case of metabolic syndrome or diabetic dyslipidemia; however, fibrates increases the risk of statin induced myopathy.[3]
- The patient should be asked about any history of excessive exercise or trauma.[3]
Symptoms
In alphabetical order
- Fatigue
- Generalized aching
- Low back or proximal muscle pain
- Myalgia
- Nocturnal muscle cramps
- Tendon pain
- Weakness[4]
References
- ↑ Bruckert E, Hayem G, Dejager S, et al.: Mild to moderate muscular symptoms with high-dosage statin therapy in hyper- lipidemic patients–the PRIMO study [see comment]. Cardiovasc Drugs Ther 2005, 19:403–414.
- ↑ Fernandez G, Spatz ES, Jablecki C, Phillips PS (2011). "Statin myopathy: a common dilemma not reflected in clinical trials". Cleve Clin J Med. 78 (6): 393–403. doi:10.3949/ccjm.78a.10073. PMID 21632911.
- ↑ 3.0 3.1 Harper CR, Jacobson TA (2010). "Evidence-based management of statin myopathy". Curr Atheroscler Rep. 12 (5): 322–30. doi:10.1007/s11883-010-0120-9. PMID 20628837.
- ↑ Toth PP, Harper CR, Jacobson TA: Clinical characterization and molecular mechanisms of statin myopathy. Expert Rev Cardiovasc Ther 2008, 6:955–969.