Accessed Oct. Bope ET, et al. In: Conn's Current Therapy Philadelphia, Pa. Rosenson RS, et al. Statin muscle-related adverse events.
Chavez LO, et al. Beyond muscle destruction: A systematic review of rhabdomyolysis for clinical practice. Critical Care. See also After a flood, are food and medicines safe to use? Arcus senilis: A sign of high cholesterol? Get moving Cholesterol concerns? Lose excess pounds Cholesterol level: Can it be too low? Cholesterol test kits: Are they accurate?
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No patient developed permanent liver dysfunction, defined by elevated total bilirubin or alkaline phosphatase levels in addition to elevated transaminase levels. Of 44 patients for whom data were available, the mean duration of statin therapy before symptom onset was 6. Among patients taking cyclosporine, one received simvastatin, 20 mg daily, with subsequent myopathy and the other reported muscle pain while taking pravastatin sodium, 10 mg daily, and later tolerated this statin without recurrent symptoms.
In 44 patients, medical records indicated recovery from statin-associated myopathy a mean of 2. The single patient with ongoing muscle pain chose to continue statin therapy because of the high risk of cardiovascular disease. Thirty-seven patients received other statins after an episode of statin-associated myopathy, with medical records providing adequate documentation of a response to that statin.
Of 4 patients tolerating the same statin, 1 noted muscle pain with the statin amiodarone and a macrolide antibiotic that resolved with discontinuation of the treatment with macrolide despite continued use of amiodarone.
Of 6 patients hospitalized for rhabdomyolysis, 4 received other statins after recovery from myositis. The first patient developed rhabdomyolysis with use of simvastatin and niacin and later reported flank pain with atorvastatin calcium; verapamil was prescribed throughout this period. The second patient experienced rhabdomyolysis while taking cerivastatin and gemfibrozil but later did well while taking atorvastatin.
The third patient with rhabdomyolysis while receiving cerivastatin and gemfibrozil also reported muscle pain while taking simvastatin. The final patient recovered from rhabdomyolysis while taking simvastatin, gemfibrozil, and verapamil and then tolerated pravastatin despite concurrent use of verapamil and fenofibrate. Thus, although the data are limited, these findings suggest that some patients with rhabdomyolysis from one statin can tolerate other statins without recurrent symptoms.
We sought but did not find predictors of intolerance to more than 1 statin. Specifically, patient age, sex, duration of statin therapy before the onset of myopathy, duration of muscle pain, and peak serum CK level were no different between individuals with and without tolerance to other statins Table 5. Likewise, disparate use of concomitant medications known to increase the risk of statin-associated myopathy was not observed between the tolerant and intolerant groups.
Because statin use is widespread, most primary care providers will encounter patients who experience an episode of statin-induced myopathy. Understanding the natural course of statin-associated myopathy will facilitate better informed consent of patients initiating such therapy and will allow caregivers to provide more complete information to their patients regarding the prognosis of the condition.
This study of statin-associated myopathy provides a spectrum of observations ranging from mild muscle pain to acute rhabdomyolysis. We describe important clinical details of statin-associated myopathy, including location of muscle pain, frequency of muscle weakness, time course of the illness, and ability to tolerate other statins after an episode of statin-associated myopathy.
Like other researchers, we found that rhabdomyolysis is often associated with the use of coexisting medications known to increase its risk. In addition, patients with clinically significant myopathy were older than those without this degree of myositis. Every patient who discontinued statin therapy experienced rapid resolution of muscle pain, typically within a month after cessation of therapy. Renal dysfunction was usually temporary but occurred in half of the patients who required hospitalization for rhabdomyolysis.
Finally, although data are limited, our findings suggest that some patients with statin-associated rhabdomyolysis may tolerate other statins without recurrent symptoms.
The most important limitation of this study is its retrospective, observational nature. We relied on health care providers to record clinical details and to order objective tests of muscle function, such as the serum CK measurement.
This study may involve selection or referral bias because patients receiving care in a tertiary center may be different from those treated in private practice. In addition, we used clinical outcomes, and most patients did not undergo objective muscle tests, such as electromyography or muscle biopsy, during or after an episode of statin-associated myopathy. The small sample size of this study is an important limitation; our study had limited power to detect individual patient characteristics that may predict adverse outcomes from statin-associated myopathy.
Finally, the data from this study cannot be used to assess the incidence of myopathy with each statin. In this study, patients with statin-associated myopathy experienced full resolution of muscle pain on the cessation of statin therapy. The actual risk of developing muscle pain as a result of taking statins is about 5 percent or less compared with taking a pill that doesn't contain medication placebo. However, studies have found that nearly 30 percent of people stopped taking the pills because of muscle aches even when they were taking a placebo.
A strong predictor you'll experience muscle aches when taking statins could be whether or not you read about the potential side effect. Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis rab-doe-my-OL-ih-sis. Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. The risk of very serious side effects is extremely low, and calculated in a few cases per million people taking statins.
Rhabdomyolysis can occur when you take statins in combination with certain drugs or if you take a high dose of statins. Occasionally, statin use could cause an increase in the level of enzymes that signal liver inflammation. If the increase is only mild, you can continue to take the drug. Rarely, if the increase is severe, you may need to try a different statin. Although liver problems are rare, your doctor may order a liver enzyme test before or shortly after you begin to take a statin.
You wouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.
It's possible your blood sugar blood glucose level may increase when you take a statin, which may lead to developing type 2 diabetes. The risk is small but important enough that the Food and Drug Administration FDA has issued a warning on statin labels regarding blood glucose levels and diabetes.
The increase generally occurs when blood sugar levels are already higher than normal and fall in the prediabetes or diabetes range when you begin taking a statin. Statins prevent heart attacks in people with diabetes, so the relevance of the mild increase in sugar values with statins observed in some people is unclear. The benefit of taking statins likely outweighs the small risk to have the blood sugar level go up. Talk to your doctor if you have concerns. The FDA warns on statin labels that some people have developed memory loss or confusion while taking statins.
These side effects reverse once you stop taking the medication. There is limited evidence to prove a cause-effect relationship, but talk to your doctor if you experience memory loss or confusion while taking statins. There has also been evidence that statins may help with brain function — in people with dementia, for example. This is still being studied. Don't stop taking your statin medication before talking to your doctor. Not everyone who takes a statin will have side effects, but some people may be at a greater risk than are others.
Risk factors include:. Grapefruit juice contains a chemical that can interfere with the enzymes that break down metabolize the statins in your digestive system. While you won't need to eliminate grapefruit entirely from your diet, ask your doctor about how much grapefruit you can have.
There are many drugs that may interact with statins, so be sure your doctor is aware of all the medicines you take when being prescribed with statins. To relieve side effects believed to be caused by statins, your doctor may recommend several options. Discuss these steps with your doctor before trying them:.
Although side effects believed to be caused by statins can be annoying, consider the benefits of taking a statin before you decide to stop taking your medication.
The researchers found little difference between rates of muscle pain in either group. They suggest that the pain may be due to other factors, such as age-related conditions, as most people in the study were 65—79 years old.
As many people are aware that statins may cause muscle pain before they take them, it is possible this could influence their perception of symptoms. However, it is important to note that this study only tested one type of statin at a low dose on one age group. Scientists will need to carry out further studies to better understand what causes statin muscle pain.
Muscle pain caused by statins can be mild, moderate, or severe. People with SAMS may experience:. People with SAMS typically experience pain in the calves and thighs. However, SAMS can affect all the skeletal muscles of the body.
A number of factors may put a person at higher risk of developing SAMS, including:. Generally, symptoms of SAMS resolve on their own if a person stops taking statins. However, if they do so without medical supervision, they may develop high levels of cholesterol. This in turn increases risk of serious conditions, including heart disease , heart attack , and stroke. If these measures do not prove effective, a doctor may suggest an alternative to statins. People should not stop or change the dosage of medications unless advised by a healthcare professional.
Scientists are still learning about what can help with statin muscle pain. However, some research suggests that the following may prove helpful:. People can also avoid consuming things that may contribute to the pain, such as alcohol, grapefruit, starfruit, and pomegranate. A person who cannot tolerate statins can consult their doctor about trying a different drug. The doctor may recommend one of the following:. These drugs are not a direct replacement for statins, and each has different uses.
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