Rhabdomyolysis associated with hydroxymethylglutaryl-coenzyme A reductase inhibitors

Jamal, Shelina M; Eisenberg, Mark J.; Christopoulos, Stavroula

doi:10.1016/j.ahj.2003.12.037

Cited by 98 publications

(27 citation statements)

References 56 publications

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“…In the subgroup of the 6 patients treated concomitantly with Policosanol and a statin, LDL was significantly lowered (17%; p = 0.005); a similar decrease was seen for the LDL in the 15 patients intolerant of any statin therapy (17%; p = 0.003). Lipid data are summarized in Table 1 and are consistent with other observations with Policosanol [1][2][3]. These observations appear to support the efficacy of using statins in combination with Policosanol and the use of Policosanol in patients intolerant of statins.…”

Section: Resultssupporting

confidence: 91%

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Policosanol, an aliphatic alcohol sugarcane derivative: use in patients intolerant of or inadequately responsive to statin therapy

2011

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Policosanol is a compound derived from sugarcane wax with low-density-lipoprotein (LDL) cholesterol-lowering properties. The aim of this study is to evaluate the effect of Policosanol on LDL cholesterol reduction in patients intolerant of statin therapy or on concomitant statin therapy but not at target LDL cholesterol levels. Twenty-one patients treated with policosanol 10 mg twice a day for 156 ± 63 days were analyzed retrospectively. Pre-and posttreatment fasting lipid profiles were collected and statistical analysis was performed as paired t-tests. Data were further analyzed into subgroups based on the presence or absence of statin therapy. In the 21 patients, LDL cholesterol decreased by 17% (p < 0.001) and total cholesterol decreased by 9.4% (p < 0.001). No significant changes were seen in high-density-lipoprotein (HDL) cholesterol or triglyceride levels. In the 6 patients treated with a statin and Policosanol, there was also a 17% LDL cholesterol reduction (p = 0.005). In the 15 patients treated only with Policosanol, LDL cholesterol was also decreased by 17% (p = 0.003). Policosanol use was observed to be associated with a mild-to-moderate (17%) decrease in LDL cholesterol. This association was observed in patients intolerant of statin therapy and in those receiving adjunctive Policosanol with statin therapy.

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Section: Resultssupporting

confidence: 91%

“…These medications have been shown generally to be safe and effective; however, statins can be associated with side effects such as hepatic inflammation with transaminase elevations, myositis, and myalgias [2]. In some patients, unwanted side effects require limiting or discontinuing the statin dose.…”

Section: Introductionmentioning

confidence: 99%

Policosanol, an aliphatic alcohol sugarcane derivative: use in patients intolerant of or inadequately responsive to statin therapy

2011

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“…fibrates) or agents that lead to elevations in statin concentrations (e.g. cyclosporine, macrolides, erythromycin, HIV protease inhibitors) (2,11,12). Other risk factors include advanced age (especially >80 years), female gender, renal insufficiency, liver disease, diabetes mellitus, hypothyroidism, trauma, surgery, alcoholism and severe exertion (2,4).…”

Section: Discussionmentioning

confidence: 98%

Managing statin-induced muscle toxicity in a lipid clinic

Blaier

Lishner

Elis

2011

Journal of Clinical Pharmacy and Therapeutics

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We show that for the majority of patients with statin-induced muscle toxicity, statin therapy can be safely and effectively continued. In cases of asymptomatic CK levels <3-5 upper limit of normal (ULN), statin treatment should not be interrupted. When CK levels >3-5 ULN or when various symptomatic muscle adverse reactions are present, statins rechallenge, after a recovery period, should be individualized either by a low dose of a potent statin or by a less potent statin. An additional lipid medication is advised if the target levels are not achieved.

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“…4 Statins are the most effective and widely prescribed drugs currently available for the reduction of low-density lipoprotein (LDL) cholesterol, which is critical for primary and secondary prevention of cardiovascular disease 5 (see Figure 1 for schematic representation of the mechanism by which statins reduce cholesterol). Rhabdomyolysis is the most severe form of myotoxicity, which can occur with all statins, either in monotherapy or in combination therapy, 6 although the exact mechanism of this link is still unknown. 7 The incidence of rhabdomyolysis from all causes is 1.6 per 100,000 person-years 8 ; the US Food and Drug Administration Adverse Event Reporting System database reports rates of statin-induced rhabdomyolysis of 0.3-13.5 cases per 1,000,000 statin prescriptions.…”

Section: Ré Sumémentioning

confidence: 99%

Statin-Induced Rhabdomyolysis: A Comprehensive Review of Case Reports

Mendes¹,

Robles²,

Mathur

2014

Physiotherapy Canada

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Purpose: To identify case reports of statin-induced rhabdomyolysis and summarize common predisposing factors, symptoms, diagnostic findings, functional outcomes, characteristics, treatment, and rehabilitation. Method: MEDLINE, CINAHL, SCOPUS, and PEDro databases were searched for relevant case reports using the search terms ''Statins,'' ''Rhabdomyolysis,'' ''Myalgia,'' ''Muscle damage,'' ''Muscle injury,'' and ''Myopathy.'' Relevance (based on title and abstract) was assessed by one investigator; two investigators independently reviewed the relevant articles to determine inclusion in the review. Results: A total of 112 cases met the inclusion criteria. The majority were in men (70%) and people over 45 years of age (mean 64 [SD 14] years). Simvastatin was the most commonly reported statin (n ¼ 55); the majority of cases reported the use of concomitant medications such as fibrates (n ¼ 25). Weakness (n ¼ 65) and muscle pain (n ¼ 64) were the most common symptoms. In 19 cases, the patient was referred to rehabilitation, but the case reports do not include descriptions of the treatment. Conclusion: Statin-induced rhabdomyolysis was more commonly reported when statins were used in conjunction with other drugs, which potentiated its effect. Research is needed to identify the role of exercise and rehabilitation following statin-induced rhabdomyoloysis since muscle damage may be severe and may have long-term effects on muscle function.Key Words: HMG-CoA; muscular diseases; rhabdomyolysis; statins. RÉ SUMÉObjectif : Trouver des rapports de cas portant sur la rhabdomyolyse provoqué e par les statines et ré sumer les facteurs pré disposants communs, les symptô mes, les ré sultats diagnostiques, les ré sultats fonctionnels, les caracté ristiques, le traitement et la ré adaptation. Mé thodes : On a cherché dans les bases de donné es MEDLINE, CINAHL, SCOPUS et PEDro (1990PEDro ( -2013 des rapports de cas pertinents en utilisant les termes de recherche Statins, Rhabdomyolysis, Myalgia, Muscle damage, Muscle injury et Myopathy. Un chercheur en a é valué la pertinence (en fonction du titre et du ré sumé ) et deux autres ont revu indé pendamment les articles pertinents pour dé terminer s'il fallait les inclure dans la recherche. Ré sultats : Au total, 112 cas ré pondaient aux critè res d'inclusion. La majorité des cas portaient sur des hommes (70 %) et les plus de 45 ans (â ge moyen de 64 [ET 14] ans). La simvastatine a é té la statine incriminé e le plus souvent dans les rapports (n ¼ 55), la majorité des cas signalant l'utilisation simultané e de mé dicaments comme des fibrates (n ¼ 25). La faiblesse (n ¼ 65) et les douleurs musculaires (n ¼ 64) é taient les symptô mes les plus courants. Dans 19 cas, le patient a é té aiguillé vers la ré adaptation, mais les rapports ne dé crivent pas le traitement. Conclusion : On a signalé une rhabdomyolyse causé e par les statines plus souvent lorsqu'elles é taient conjugué es à d'autres mé dicaments, ce qui en a accentué l'effet. Des recherches s'imposent pour dé terminer le rô le ...

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Rhabdomyolysis associated with hydroxymethylglutaryl-coenzyme A reductase inhibitors

Cited by 98 publications

References 56 publications

Policosanol, an aliphatic alcohol sugarcane derivative: use in patients intolerant of or inadequately responsive to statin therapy

Policosanol, an aliphatic alcohol sugarcane derivative: use in patients intolerant of or inadequately responsive to statin therapy

Managing statin-induced muscle toxicity in a lipid clinic

Statin-Induced Rhabdomyolysis: A Comprehensive Review of Case Reports

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