Muscle Toxicity of Drugs: When Drugs Turn Physiology into Pathophysiology

Abstract

Drugs are prescribed to manage or prevent symptoms and diseases, but may sometimes cause unexpected toxicity to muscles. The symptomatology and clinical manifestations of the myotoxic reaction can vary significantly between drugs and between patients on the same drug. This poses a challenge on how to recognize and prevent the occurrence of drug-induced muscle toxicity. The key to appropriate management of myotoxicity is prompt recognition that symptoms of patients may be drug related and to be aware that inter-individual differences in susceptibility to drug-induced toxicity exist. The most prevalent and well-documented drug class with unintended myotoxicity are the statins, but even today new classes of drugs with unintended myotoxicity are being discovered. This review will start off by explaining the principles of drug-induced myotoxicity and the different terminologies used to distinguish between grades of toxicity. The main part of the review will focus on the most important pathogenic mechanisms by which drugs can cause muscle toxicity, which will be exemplified by drugs with high risk of muscle toxicity. This will be done by providing information on key clinical and laboratory aspects, muscle electromyography patterns and biopsy results, and pathological mechanism and management for a specific drug from each pathogenic classification. In addition, rather new classes of drugs with unintended myotoxicity will be highlighted. Furthermore, we will explain why it is so difficult to diagnose drug-induced myotoxicity, and which tests can be used as a diagnostic aid. Lastly, a brief description will be given of how to manage and treat drug-induced myotoxicity.

Probiotic Effects of Lactobacillus fermentum ZJUIDS06 and Lactobacillus plantarum ZY08 on Hypercholesteremic Golden Hamsters

“…The prescribed use of statin drugs reduces the risk of developing atherosclerotic cardiovascular disease (6,7), cardiovascularrelated death, and death in general, by lowering LDL-C levels (8)(9)(10). However, the use of statins on a regular basis has been associated with multiple adverse effects, including liver damage, liver necrosis, kidney damage, myopathy, and rhabodomyolysis (6,11,12), asks for the development of alternative agents or bioactives with cholesterol-lowering characteristics.…”

Naringin Ameliorates Skeletal Muscle Atrophy and Improves Insulin Resistance in High-Fat-Diet-Induced Insulin Resistance in Obese Rats

“…Conversely, the skeletal muscle parameters from the histological analysis in our study of the naringin treatment were higher than both the HFD and the HFD + SIM groups. A previous study showed that the effect of statin on the morphology of muscle fibres, induced myopathy, which comprised muscle atrophy, necrosis, and inflammation [ 36 ]. Similarly, the histological aspects of the muscle fibres in the HFD + SIM group in our study were split and had irregular shapes and sizes when compared with the control and naringin treatment groups, which is consistent with the previous study [ 9 ].…”

Skeletal muscle and childhood cancer: Where are we now and where we go from here

“…In adults, drug-induced myopathies primarily cause weakness in proximal muscles of the legs and arms. 222 Whether this is consistent for children with cancer is unknown. Yang and Choi 74 followed 30 children (mean age: 10.9 ± 3.8) newly diagnosed with cancer (hematologic malignancies n = 19, solid tumors n = 11) during their first year of cancer treatment.…”