Statins Therapy Update- Rhabdomylosis

statins 

“Statins” is a class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that is responsible for making cholesterol. 

The most common side effects are

  • headache,
  • nausea,
  • vomiting,
  • constipation,
  • diarrhea,
  • rash,
  • weakness, and
  • muscle pain. 

The most serious side effects are liver failure and rhabdomyolysis. Rhabdomyolysis is a rare serious side effect which involves damage to muscles. Rhabdomyolysis often begins as muscle pain and can progress to loss of muscle cells, kidney failure, and death. It occurs more often when statins are used in combination with other drugs that themselves cause rhabdomyolysis or with drugs that prevent the elimination of statins and raise the levels of statins in the blood. Since rhabdomyolysis may be fatal, unexplained joint or muscle pain that occurs while taking statins should be brought to the attention of a health care professional for evaluation. Statins must not be used during pregnancy because of the risk of serious adverse effects to the developing fetus. 

With which drugs do statins interact? 

Statins have some important drug interactions. The first type of interaction involves the enzymes responsible for the elimination of statins by the liver. Liver enzymes (specifically, the cytochrome P-450 liver enzymes) are responsible for eliminating all statins from the body with the exception of pravastatin and rosuvastatin. Therefore, drugs that block the action of these liver enzymes increase the levels of simvastatin, lovastatin, fluvastatin, and atorvastatin (but not pravastatin or rosuvastatin) in the blood and can lead to the development of rhabdomyolysis. Drugs or agents that block these enzymes include: 

  • protease inhibitors (for example, indinavir, ritonavir used in treating AIDS,
  • erythromycin,
  • itraconazole,
  • clarithromycin,
  • telithromycin
  • cyclosporine
  • boceprevir
  • telaprevir
  • voriconazole
  • diltiazem,
  • verapamli and
  • grapefruit juice

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