Rhabdomyolysis and HMG-CoA Reductase Inhibitors

Omar, Mohamed A.; Wilson, James P.; Cox, Tamara S

doi:10.1345/aph.10228

Cited by 277 publications

(163 citation statements)

References 83 publications

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“…Drug interactions are a reason for concern since they can result in potential muscle toxicity and liver dysfunction. Simvastatin and lovastatin are extensively metabolized by CYP3A4 and should probably be avoided in patients receiving PIs (CYP3A4 inhibitors) since the interaction could promote excessive levels of the statin and increase the risk of severe rhabdomyolysis [56, 58]. This risk would be even larger if a fibrate is also part of the therapeutic regimen [58].…”

Section: New Insights Into the Mechanisms Of Stroke In Hiv-infected Pmentioning

confidence: 99%

“…Simvastatin and lovastatin are extensively metabolized by CYP3A4 and should probably be avoided in patients receiving PIs (CYP3A4 inhibitors) since the interaction could promote excessive levels of the statin and increase the risk of severe rhabdomyolysis [56, 58]. This risk would be even larger if a fibrate is also part of the therapeutic regimen [58]. The possibility of muscle damage is particularly worrisome in HIV-infected patients who may develop hyperlactatemia and, occasionally, severe muscle injury from mitochondrial toxicity induced by nucleoside analog reverse transcriptase inhibitors [59].…”

Section: New Insights Into the Mechanisms Of Stroke In Hiv-infected Pmentioning

confidence: 99%

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Stroke in HIV-Infected Patients: A Clinical Perspective

Rabinstein¹

2003

Cerebrovasc Dis

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The occurrence of stroke in patients with human immunodeficiency virus (HIV) infection has been traditionally associated with opportunistic infections and tumors, and advanced stages of immunosuppression. However, this reality is undergoing major changes. Effective antiretroviral regimens are now able to forestall the progression of HIV infection and avoid early mortality. As HIV-infected patients are growing older, clinicians are facing new challenges, including an increasing incidence of vascular complications. The use of protease inhibitors is associated with a variety of metabolic derangements that could produce accelerated atherosclerosis. Cerebrovascular hemodynamic function is impaired in HIV-infected patients with evidence of abnormal vasoreactivity even in otherwise healthy individuals. The potential contribution from these novel mechanisms should be added to the high incidence of classic vascular risk factors in the HIV-infected population and the cardiac abnormalities frequently observed in these patients. Large-scale epidemiological studies should be carried out to define the true incidence of stroke in HIV-infected patients and the factors associated with its occurrence.

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Section: New Insights Into the Mechanisms Of Stroke In Hiv-infected Pmentioning

confidence: 99%

Section: New Insights Into the Mechanisms Of Stroke In Hiv-infected Pmentioning

confidence: 99%

Stroke in HIV-Infected Patients: A Clinical Perspective

Rabinstein¹

2003

Cerebrovasc Dis

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“…Muscle symptoms usually occur within the first 6 mo of starting statins but can occur months or years after the initiation of statin therapy and automatically resolve within 2 mo of discontinuing statin therapy [128] . The incidence of statin-associated myopathy is quite low (approximately 0.01%) and rhabdomyolysis even lower (0.002%) [129] . Fatal rhabdomyolysis has been estimated to occur in approximately 1.5 in 10 million prescriptions [130] .…”

Section: Side Effects Of Statin Chemopreventionmentioning

confidence: 97%

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Tsibouris

Vlachou

Isaacs

2014

WJGPT

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The incidence of esophageal adenocarcinoma, a poor prognosis neoplasia, has risen dramatically in recent decades. Barrett's esophagus represents the best-known risk factor for esophageal adenocarcinoma development. Non-steroidal anti-inflammatory drugs through cyclooxygenase-2 inhibition and prostaglandin metabolism regulation could control cell proliferation, increase cell apoptosis and regulate the expression of growth and angiogenic factors. Statins can achieve equivalent effects through prenylation and subsequently control of cellular signaling cascades. At present, epidemiological studies are small and underpowered. Their data could not justify either medication as a chemo-preventive agent. Population based studies have shown a 43% reduction of the odds of developing an esophageal adenocarcinoma, leaving out or stating a 25% reduction in patients consuming non-aspirin nonsteroidal antiinflammatory drugs and a 50% reduction in those patients consuming aspirin. They have also stated a 19% reduction of esophageal cancer incidence when statins have been used. Observational studies have shown that non-steroidal anti-inflammatory drugs could reduce the adenocarcinoma incidence in patients with Barrett's esophagus by 41%, while statins could reduce the risk by 43%. The cancer preventive effect has been enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Observational data are equivocal concerning the efficacy of non-steroidal anti-inflammatory drug subclasses. Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. In conclusion, both non-steroidal anti-inflammatory drugs and statins are promising chemopreventive agents and deserve further exploration with interventional studies. In the meanwhile, their use is justified only in patients with cardiovascular disease.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Esophageal adenocarcinoma; Barrett's esophagus; Non-steroidal anti-inflammatory drugs; Aspirin; Statins; Cancer chemoprevention Core tip: Esophageal adenocarcinoma remains a major burden upon health. Experimental studies have suggested that non-steroidal anti-inflammatory drugs and statins may have useful actions against esophageal cancer cells. This review of observational studies shows that non-steroidal anti-inflammatory drugs reduced adenocarcinoma incidence in patients with Barrett' s esophagus by 41%, while statins reduced the risk by 43%. The cancer preventive effect is enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. Their combination offers promise for chemoprevention and further interventional studies are warranted.Tsibouris P, Vlachou E, Isaacs PET. Role of chemoprophylaxis REVIEWOnline Submissions: http://www.wjgnet.com/esps/

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“…Einzelfälle schwerer Rhabdomyolysen wurden zumeist nur als Wechselwirkungen mit anderen Medikamenten berichtet. Insbesondere galt dies für die lipidsenkende Kombinationstherapie von Statinen mit Fibraten [3,5,6,19,20] (Übersicht bei [17,23]), welches zu der Veröffentlichung von mehreren Warnhinweisen seitens der Hersteller führte [29].…”

Section: Schlüsselwörterunclassified

“…eine akute Rhabdomyolyse mit Myoglobinurie und drohendem, akutem Nierenversagen als sehr selten [5,11]. Allerdings gibt es Hinweise, dass sich eine mäßige, klinisch asymptomatische Erhöhung der CK in 3-5% der mit Statinen behandelten Fälle finden kann [17], wobei empfohlen wird, die Therapie zu beenden, wenn die CKWerte das Dreifache des oberen Normwertes überschreiten [11].…”

Section: Diskussionunclassified

Rhabdomyolyse unter Cerivastatin-Monotherapie

Sparing¹,

Sellhaus²,

Noth³

et al. 2003

Der Nervenarzt

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Cerivastatine was administered as a reversible HMG-CoA reductase inhibitor (statine) to treat hypercholesterolemia until its withdrawal from the market following 52 reports of death due to drug-related rhabdomyolysis and acute renal failure. In most cases, cerivastatine was applied in combination with drugs which influenced the liver metabolism of cerivastatine via cytochromeoxidase P 450 isoenzymes. We report a well-documented case of acute rhabdomyolysis following cerivastatine monotherapy. The diagnosis was confirmed additionally by muscle biopsy.Finally,we give an overview of the current knowledge concerning therapy with HMG-CoA reductase inhibitors,1 year after the withdrawal of cerivastatine from the market.

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Rhabdomyolysis and HMG-CoA Reductase Inhibitors

Abstract: Rhabdomyolysis is a rare but clinically important adverse event of statin monotherapy or combination therapy. Thorough understanding of this condition may help prevent or minimize adverse health outcomes in patents receiving statin therapy.

Cited by 277 publications

References 83 publications

Stroke in HIV-Infected Patients: A Clinical Perspective

Stroke in HIV-Infected Patients: A Clinical Perspective

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Rhabdomyolyse unter Cerivastatin-Monotherapie

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