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Statin-Induced Myopathy

Aka: Statin-Induced Myopathy, Rhabdomyolysis due to Statin, Statin-Induced Myalgias, Myositis due to Statins, Statin Myopathy
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  1. See Also
    1. Statin
  2. Epidemiology
    1. Statin-Induced Myalgias are common (5%)
    2. Statin-induced Rhabdomyolysis is uncommon (0.1%)
  3. Mechanism
    1. Typical Myopathy
      1. Muscle injury secondary to Statin use (drug-induced Myopathy - accelerating muscle cell death)
    2. Statin-Induced Immune-mediated Necrotizing Myopathy
      1. Newly defined in 2011
      2. Symptoms and findings (including CPK) remain abnormal after stopping the Statin
  4. Symptoms
    1. Myalgia
      1. Muscle ache or weakness with normal CPK
    2. Myostitis
      1. Muscle ache or weakness with CPK elevated but <10 fold increase above normal
    3. Rhabdomyolysis
      1. Muscle ache or weakness with CPK elevated but >10 fold increase above normal
  5. Symptoms: Red Flags
    1. Patient should stop Statin and contact physician if following symptoms experienced
    2. Severe myalgias
    3. Muscle Weakness
    4. Dark urine
  6. Labs
    1. Creatine Phosphokinase (CPK)
      1. Poor marker for myalgias (only increased in Myositis or Rhabdomyolysis)
      2. Normal in most patients despite myalgias
      3. Abnormal CPK suggests Myositis or Rhabdomyolysis and requires immediate cessation of Statin
    2. Additional labs in CPK Elevation (especially Rhabdomyolysis)
      1. Urine Myoglobin
      2. Renal Function
  7. Differential Diagnosis
    1. See Myopathy Causes
    2. Consider checking serum Vitamin D level
  8. Risk factors: Statin induced Myopathy
    1. Combination with Gemfibrozil
    2. Drug interactions (see Statins)
      1. Raised serum Statin levels result in higher myalgia or Myositis risk
    3. Older patients over age 70 years
    4. Low body weight
    5. Female gender
    6. Acute illness or major surgery
    7. Alcohol Abuse or other Substance Abuse (e.g. Cocaine, Amphetamines)
    8. Hypothyroidism
    9. Chronic Kidney Disease Stage 4 (Creatinine Clearance <30 ml/min)
    10. High dose Statin use (dose greater than 50% of maximum dose, especially Simvastatin 80 mg)
  9. Management: Symptomatic
    1. Coenzyme Q10 (Ubiquinone) 100 mg orally daily
      1. Reduces myalgias by 40%
      2. Caso (2007) Am J Cardiol 99:1409-12
    2. Decrease Statin dose by 50%
    3. Consider change to alternative Statin
      1. Initially thought that hydrophilic Statins (Pravastatin, Rosuvastatin) were less likely to cause myalgias
      2. Hydrophilic Statins do not appear to offer any increased benefit over other Statins regarding myalgia risk
        1. Thompson (2003) JAMA 289(13): 1681-90
  10. References
    1. Bruckert (2005) Cardiovasc Drugs Ther 19(6): 403-14
    2. Graham (2004) JAMA 292(21): 2585-90
    3. Phillips (2002) Ann Intern Med 137:581-5

Myositis (C0027121)

Definition (MSH) Inflammation of a muscle or muscle tissue.
Definition (NCI) An inflammatory process affecting the skeletal muscles. Causes include infections, injuries, and autoimmune disorders.
Definition (NCI) A disorder characterized by inflammation involving the skeletal muscles.
Definition (SNOMEDCT) Inflammation of skeletal muscle, not including inflammation of cardiac muscle
Definition (MEDLINEPLUS)

Myositis is inflammation of your skeletal muscles, which are also called the voluntary muscles. These are the muscles you consciously control that help you move your body. An injury, infection or autoimmune disease can cause myositis.

The diseases dermatomyositis and polymyositis both involve myositis. Polymyositis causes muscle weakness, usually in the muscles closest to the trunk of your body. Dermatomyositis causes muscle weakness, plus a skin rash. Both diseases are usually treated with prednisone, a steroid medicine, and sometimes other medicines.
Definition (CSP) inflammation of skeletal muscle.
Concepts Disease or Syndrome (T047)
MSH D009220
ICD10 M60, M60.9, G72.49
SnomedCT 203110007, 26889001, 128496001, 268108002
English Myositides, MYOSITIS, Myositis, NOS, Myositis unspecified, Myositis, unspecified, INFLAMM MUSCLE DIS, MUSCLE DIS INFLAMM, INFLAMM MYOPATHY, MYOPATHY INFLAMM, inflammatory myopathy, inflammatory myopathy (diagnosis), MYOSITIS INFLAMMATORY, Inflammatory Muscle Disease, Inflammatory Muscle Diseases, Muscle Disease, Inflammatory, Muscle Diseases, Inflammatory, Inflammatory Myopathies, Inflammatory Myopathy, Myopathies, Inflammatory, Myopathy, Inflammatory, Myositis unspecified (disorder), Inflammatory myopathy NOS, Myositis [Disease/Finding], Myositis, Unspecified myositis, inflammation of the skeletal muscle, inflammatory muscle disease, inflammatory muscle diseases, myositis nos, Inflammation;muscle(s), muscle inflammation, inflammatory myopathies, Inflammatory disorder of muscle (disorder), Inflammatory disorder of muscle, Inflammatory myopathy, Myositis (disorder), myositis, disease (or disorder); muscle, inflammatory, inflammation; muscle, inflammatory; myopathy, muscle; disease, inflammatory, muscle; inflammation, myopathy; inflammatory, Myositis NOS, Muscle inflammation, inflammation of the muscle(s)
French MYOSITE, Inflammation musculaire, Myosite, Maladies inflammatoires des muscles, Myopathie inflammatoire
Portuguese MIOSITE, Inflamação muscular, Miosite, Miopatia Inflamatória
Spanish MIOSITIS, Inflamación muscular, Myositis NOS, miopatía inflamatoria (trastorno), miopatía inflamatoria, miositis (trastorno), miositis, no especificada (trastorno), miositis, no especificada, miositis, trastorno muscular inflamatorio, Miositis, Miopatía Inflamatoria, Miopatia Inflamatoria
German MYOSITIS, Muskelentzuendung, Myositis, nicht naeher bezeichnet, Myositis, Entzündliche Myopathie, Muskelentzündung
Dutch spierontsteking, aandoening; spier, inflammatoir, inflammatoir; myopathie, myopathie; inflammatoir, ontsteking; spier, spier; aandoening, inflammatoir, spier; ontsteking, Myositis, niet gespecificeerd, myositis, Inflammatoire myopathie, Myositis
Italian Infiammazione muscolare, Miosite
Japanese 筋肉の炎症, ｷﾝｴﾝ, ｷﾝﾆｸﾉｴﾝｼｮｳ, 筋炎, 筋肉炎
Swedish Muskelinflammation
Czech myozitida, zánětlivé nemoci svalů, svaly - zánět, zánětlivá myopatie, Zánět svalu, Myozitida
Finnish Myosiitti
Russian MIOZIT, МИОЗИТ
Korean 근육염, 상세불명의 근육염
Croatian UPALA MIŠIĆA, MIOZITIS
Polish Zapalenie mięśni eozynofilowe, Zapalenie mięśni
Hungarian Myositis, Izomgyulladás
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hydroxymethylglutaryl-CoA Reductase Inhibitors (C0360714)

Definition (NCI) A class of agents that inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis.
Definition (CHV) cholesterol lowering drug
Definition (NCI) Any of a group of drugs that lower the amount of cholesterol and certain fats in the blood. Statins inhibit a key enzyme that helps make cholesterol. Statin drugs are being studied in the prevention and treatment of cancer.
Definition (MSH) Compounds that inhibit HMG-CoA reductases. They have been shown to directly lower cholesterol synthesis.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D019161
SnomedCT 372912004, 96302009
English HMG CoA Reductase Inhibitors, HMG-CoA Reductase Inhibitors, Inhibitors, HMG-CoA Reductase, Reductase Inhibitors, HMG-CoA, HMG-COA REDUCTASE INHIBITORS, HMG-CoA reductase inhibitor, NOS, Hydroxymethylglutaryl CoA Reductase Inhibitors, Hydroxymethylglutaryl-CoA Inhibitors, Hydroxymethylglutaryl-Coenzyme A Inhibitors, Inhibitors, HMG CoA Reductase, Inhibitors, Hydroxymethylglutaryl CoA, Inhibitors, Hydroxymethylglutaryl Coenzyme A, Inhibitors, Hydroxymethylglutaryl-CoA, Inhibitors, Hydroxymethylglutaryl-CoA Reductase, Inhibitors, Hydroxymethylglutaryl-Coenzyme A, Reductase Inhibitors, Hydroxymethylglutaryl-CoA, Statin, 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (substance), 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, INHIB HMG COA REDUCTASE, INHIB HYDROXYMETHYLGLUTARYL COA, HMG COA REDUCTASE INHIB, HYDROXYMETHYLGLUTARYL COA REDUCTASE INHIB, HMG-CoA reductase inhibitors (medication), HMG-CoA reductase inhibitors, 808 HMG-COA REDUCTASE INHIBITORS, HMG-CoA Reductase Inhibitor, HMG-CoA Reductase Inhibitor [EPC], Hydroxymethylglutaryl-CoA Reductase Inhibitor, hydroxymethylglutaryl-coenzyme A reductase inhibitor, statin, HMG-CoA Statins, Statins, HMG CoA, Statins, HMG-CoA, HMG COA reductase inhibitor, HMG-CoA reductase inhibitor (product), HMG-CoA reductase inhibitor, Statins, HMG-CoA reductase inhibitor (substance), Hydroxymethylglutaryl CoenzymeA Reductase Inhibitors, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) Reductase Inhibitors, Hydroxymethylglutaryl-CoA Reductase Inhibitors
Spanish inhibidor de la HMG - CoA reductasa, inhibidor de 3-hidroxi-3-metilglutaril coenzima A reductasa, inhibidor de 3-hidroxi-3-metilglutaril coenzima A reductasa (sustancia), inhibidor de la HMG - CoA reductasa (sustancia), inhibidor de la HMG-CoA reductasa (producto), inhibidor de la HMG-CoA reductasa (sustancia), inhibidor de la HMG-CoA reductasa, estatina, inhibidor de la 3-hidroxi-3-metilglutaril coenzima A reductasa, Estatinas HMG-CoA, Inhibidores de Hidroximetilglutaril-CoA Reductasas, Inhibidores de HMG CoA Reductasa
French Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase, Inhibiteurs de l'hydroxyméthylglutaryl-Coenzyme A réductase, Inhibiteurs de l'HMG-CoA réductase, Statines
Swedish Hydroximetylglutaryl-CoA-reduktashämmare
Czech HMG-CoA-reduktasa - inhibitory, hydroxymethylglutaryl-CoA-reduktasa - inhibitory, statiny
Finnish Hydroksimetyyliglutaryyli-KoA-reduktaasin estäjät
Russian GIDROKSIMETILGLUTARIL-KOA-REDUKTAZY INGIBITORY, HMG-COA REDUKTAZY INGIBITORY, GIDROKSIMETILGLUTARIL-KOA REDUKTAZY INGIBITORY, GMG-KOA REDUKTAZY INGIBITORY, STATINY GMG-KOA-REDUKTAZY, HMG-COA-РЕДУКТАЗЫ СТАТИНЫ, СТАТИНЫ ГМГ-КОA-РЕДУКТАЗЫ, HMG-COA-REDUKTAZY STATINY, HMG-COA РЕДУКТАЗЫ ИНГИБИТОРЫ, ГИДРОКСИМЕТИЛГЛУТАРИЛ-КОA-РЕДУКТАЗЫ ИНГИБИТОРЫ, ГИДРОКСИМЕТИЛГЛУТАРИЛ-КОА РЕДУКТАЗЫ ИНГИБИТОРЫ, ГМГ-КОA РЕДУКТАЗЫ ИНГИБИТОРЫ, ГМГ-КОА РЕДУКТАЗЫ ИНГИБИТОРЫ
Japanese ヒドロキシメチルグルタリルCoAレダクターゼ抑制剤, ヒドロキシメチルグルタリル-CoAレダクターゼ阻害剤, ヒドロキシメチルグルタリルCoAレダクターゼ阻害剤, HMG-CoA還元酵素阻害剤, HMG-CoAレダクターゼ抑制剤, HMG-CoAレダクターゼ阻害剤, HMG-CoAレダクターゼインヒビター, HMG-CoA還元酵素阻害薬
Polish Statyny, Inhibitory reduktazy 3-hydroksy-3-metyloglutarylokoenzymu A, HMG-CoA, Inhibitory reduktazy hydroksymetyloglutarylo CoA
German HMG-CoA-Reduktase-Inhibitoren, Hydroxymethylglutaryl-CoA-Reductase-Inhibitoren, Hydroxymethylglutaryl-CoA-Reduktase-Inhibitoren, Inhibitoren, HMG-CoA Reduktase, Inhibitoren, Hydroxymethylglutaryl-CoA, Inhibitoren, Hydroxymethylglutaryl-Coenzym A, Statine, HMG-CoA
Italian Inibitori della reduttasi del coenzima A idrossimetilglutarilico
Portuguese Estatinas de HMG-CoA, Inibidores de Hidroximetilglutaril-CoA Redutases, Inibidores de HMG-CoA Redutases
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Drug-induced myopathy (C0410220)

Concepts Pathologic Function (T046)
ICD10 G72.0
SnomedCT 193242006, 240101000
Spanish Drug-induced myopathy, miopatía inducida por drogas (trastorno), miopatía inducida por drogas
German Arzneimittelinduzierte Myopathie
Korean 약물유발성 근육병증
English drug induced myopathy, drug-induced myopathy, Drug-induced myopathy, Drug-induced myopathy (disorder), drugs; myopathy, myopathy; drugs
Dutch geneesmiddel; myopathie, myopathie; geneesmiddelen, Myopathie ten gevolge van geneesmiddelengebruik
Sources
Derived from the NIH UMLS (Unified Medical Language System)


drug-induced rhabdomyolysis (C2200329)

Concepts Pathologic Function (T046)
English drug-induced rhabdomyolysis (diagnosis), drug-induced rhabdomyolysis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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