Prevention and management of statin adverse effects: A practical approach for pharmacists

Barry, Arden R.; Beach, Jessica E; Pearson, Glen J.

doi:10.1177/1715163518768534

Cited by 20 publications

(17 citation statements)

References 30 publications

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“…The onset of muscle symptoms is usually within weeks to months after the beginning of statin therapy but it also may occur at any time during treatment. Regarding serum CK levels, it is useful to obtain a baseline CK level for reference purposes prior to starting statin therapy but the routinely monitoring serum CK levels is not recommended on statin therapy 11. One differential characteristic of IMNM is that statin withdrawal does not usually improve the patient’s symptoms and inmunosuppressive treatment is required to obtain a clinical response 9…”

Section: Discussionmentioning

confidence: 99%

Statin-induced autoimmune myopathy: a case report

Alzueta¹,

Marin²,

Castresana³

et al. 2019

Eur J Hosp Pharm

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Statins are widely used in the treatment of hypercholesterolemia. Muscle weakness and elevated creatine kinase (CK) are frequent side effects of statins with an incidence of about 15%. Statin-associated myopathy is more common in people who receive multiple drugs, the elderly or women but the mechanism underlying it is still unclear. These symptoms generally improve after drug discontinuation. However, there is a type of autoimmune mediated myopathy characterised by the persistence of muscle weakness and CK elevation after stopping statins. Herein, we discuss a case of autoimmune myopathy associated with statin exposure and responsive to immunossupresive drugs. The increased use of statins in recent years raises the importance of acquaintance with this disease in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Statin-induced autoimmune myopathy: a case report

Alzueta¹,

Marin²,

Castresana³

et al. 2019

Eur J Hosp Pharm

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“…The following mild-to-moderate symptoms of statin-induced myopathy, including fatigue, muscle pain, muscle tenderness, muscle weakness, nocturnal cramping, and tendon pain, were recorded at the time of enrollment. Patients with the abovementioned symptoms with serum CK levels more than five times the normal values were grouped under statin-induced myopathy group, and rest of the patients without the symptoms and normal CK values were grouped as nonmyopathy group or tolerant group18, 19.…”

Section: Methodsmentioning

confidence: 99%

Impact of pharmacogenetics on statin-induced myopathy in South-Indian subjects

Ramakumari

Indumathi

Katkam

et al. 2018

Indian Heart Journal

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ObjectivesStatins are the most commonly prescribed medications for the treatment of atherosclerotic cardiovascular disease. Statin-associated adverse effects occur in ∼10% of patients and are associated with polymorphisms in several key genes coding for transporters and metabolizing enzymes that affect statin pharmacokinetics. In the present study, we examine the association between cytochrome P450 3A5*3 (CYP3A5*3) T>C (rs776746), COQ G>C (rs4693075), and SLCO1B1 T>C (rs4149056) genetic variants with the risk of myopathy in South Indian patients on statin therapy.MethodsA total of 202 patients on atorvastatin or rosuvastatin therapy for 12 years were recruited in the study. Genotyping of drug metabolic CYP3A5*3 gene variant and drug transporter genes COQ G>C (rs4693075) and SLCO1B1 T>C (rs4149056) was analyzed by Sanger's sequencing.ResultsIn our study subjects, the percentage of patients diagnosed to have statin-induced myopathy was 18%. The majority of the patients were on 10 mg/day dose of either atorvastatin or rosuvastatin. The homozygous nonexpressors genotype CYP3A5*3/3 frequency of the CYP3A5 polymorphism was higher in patients with myopathy. But we could not find association of CYP3A5, COQ, and SLCO1B1 gene polymorphisms with either rosuvastatin or atorvastatin.ConclusionOur results clearly demonstrate that the frequency of CYP3A5*3 splicing variant is higher in myopathy group than in the tolerant group. We did not find significant association of genetic polymorphisms in CYP3A5, COQ, and SLCO1B1 with atorvastatin- or rosuvastatin-induced myopathy.

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“…When the CK level reaches a value 10 times greater than the superior limit, the physician has to evaluate the danger/advantages of giving up the drug treatment, even if the drug may be needed. As a general guideline, in a patient at high risk who previously suffered an MI, presenting myalgia with normal serum CK levels and without muscle weakness, ceasing the statin administration is not advisable [ 96 ]. In clinical practice, muscle symptoms related to statin administration are frequent and occur in about 30% of patients [ 96 ].…”

Section: Benefits Vs Risks Of Statin Treatmentsmentioning

confidence: 99%

“…As a general guideline, in a patient at high risk who previously suffered an MI, presenting myalgia with normal serum CK levels and without muscle weakness, ceasing the statin administration is not advisable [ 96 ]. In clinical practice, muscle symptoms related to statin administration are frequent and occur in about 30% of patients [ 96 ]. A recent study performed by a Canadian team presented six main directions in managing subjects intolerant to statins.…”

Section: Benefits Vs Risks Of Statin Treatmentsmentioning

confidence: 99%

“…A careful evaluation of the laboratory and clinical data of the patient has to be carried out for every subject showing muscle symptoms during statin treatment, then using a de-challenge or a re-challenge procedure. Despite intolerance to a certain statin, determined by muscle symptoms, most subjects can tolerate another statin; as there is no proof of cardiovascular advantages of non-statin drugs used alone, this fact is of the utmost relevance [ 96 ].…”

Section: Benefits Vs Risks Of Statin Treatmentsmentioning

confidence: 99%

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Cardiovascular Risk and Statin Therapy Considerations in Women

et al. 2020

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Despite major progress in the prevention and treatment of cardiovascular diseases, women remain an underdiagnosed and insufficiently treated group, with higher hospitalization and death rates compared to men. Obesity, more frequently encountered in women, raises the risk of metabolic syndrome and cardiovascular diseases as women age. There are some differences based on sex regarding the screening, diagnosis, and treatment of dyslipidemia, as it has been observed that women are less frequently prescribed statins and, when they are, they receive lower doses, even after myocardial infarction or coronary revascularization. Real-life data show that, compared to men, women are at higher risk of non-adherence to statin treatment and are more predisposed to discontinue treatment because of side effects. Statin metabolism has some particularities in women, due to a lower glomerular filtration rate, higher body fat percentage, and overall faster statin metabolism. In women of fertile age, before initiating statin treatment, contraception methods should be discussed because statins may have teratogenic effects. Older women have a higher likelihood of polypharmacy, with greater potential for drug interactions when prescribing a statin.

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Prevention and management of statin adverse effects: A practical approach for pharmacists

Cited by 20 publications

References 30 publications

Statin-induced autoimmune myopathy: a case report

Statin-induced autoimmune myopathy: a case report

Impact of pharmacogenetics on statin-induced myopathy in South-Indian subjects

Cardiovascular Risk and Statin Therapy Considerations in Women

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