Muscle pain simvastatin

Simvastatin is a statin. Patients taking statins must be advised to immediately report any unexplained muscle pain, tenderness and weakness and to take the dose preferably at night. Patients must also be advised to follow dietary measures, namely ovoid fatty foods and maintain a high-fibre diet. 

Ezetimibe/Simvastatin (Vytorin) [Antilipemic/HMG CoA Reductose Inhibitor] Uses H rp cholest olemia Action X Absorption of cholesterol phytost ol w/ HMG-CoA reductase inhibitor Dose 10/10-10/80 mg/d PO w/ cyclosporine or danazol 10/10 mg/d max w/ amio-darone or verapamil 10/20 mg/d max -1- w/ sev e renal insuff Caution [X, -] w/ CYP3A4 inhibitors (Table VI-8), gemfibrozil, niacin >lg/d, danazol, amiodarone, verapamil Contra PRG/lactation livCT Dz, t LFTs Disp Tabs SE HA, GI upset, myalgia, myopathy (muscle pain, weakness, or tendOTiess w/ CK 10 x ULN, rhab-domyolysis), Hep, Infxn Interactions t Risk of myopathy W7 clarithromycin, erythromycin, itraconazole, ketoconazole EMS None OD Sxs unknown symptomatic and supportive... 

Simvastatin (Zocor) [Anrilipemic/HMG-CoA Reductase Inhibitor] Uses X Cholesterol Action HMG-CoA reductase inhibitor Dose Adults. 5-80 mg PO w/ meals X in renal insuff Peds. 10-17 y 10 mg, 40 mg/daily max Caution [X, —] Avoid concurrent use of gemfibrozil Contra PRG, liver Dz Disp Tabs 5,10, 20, 40, 80 mg SE HA, GI upset, myalgia, myopathy (muscle pain, tenderness or weakness w/ creatine kinase 10 x ULN), Hep Interactions T Effects OF digoxin, warfarin T risk of myopathy/iiiabdomyolysis W/ amiodarone, cyclosporine, CYP3A4 inhibitors, fibrates, HIV protease inhibitors, macrolides, niacin, verapamil, grapefruit juice X effects W/ cholestyramine, colestipol, fluvas-tatin, isradipine, propranolol EMS T Effects of warfarin use amiodarone and... 

An elderly lady with chronic renal insufficiency developed rhabdomyolysis during simvastatin therapy (50). Her symptoms of muscle pain, fatigue, myoglobuli-nuria, oliguria, and pulmonary edema occurred 48 hours after the first dose of simvastatin. Simvastatin was immediately withdrawn, and she was dialysed for 1 week. 

A 56-year-old man taking simvastatin was given clarithromycin and amiodarone for pneumonia and a supraventricular tachycardia. He found it difficult to move and complained of general weakness and muscle pain. The blood creatine kinase activity was over 20 000 IU/... 

A 63-year-old white man with insulin-dependent diabetes and recent coronary artery bypass surgery developed diffuse muscle pain with generalized muscular weakness after taking amiodarone 1 g/day for 10 days then 200 mg/ day plus simvastatin 40 mg/day (37). He had a significant increase in creatine kinase activity, peaking at 40 392 U/l. 

A 75-year-old-man taking simvastatin 80 mg/day and diltiazem 240 mg/day developed extreme weakness and diffuse muscle pain. All drugs were withdrawn and he underwent hemodialysis. Within 3 weeks his muscle pain disappeared and he regained function in his legs. The activities of creatine kinase and transaminases gradually returned to normal, but he continued to need hemodialysis. 

A 64-year-old African-American man developed worsening renal insufficiency, raised creatine kinase activity, diffuse muscle pain, and severe muscle weakness. He had been taking simvastatin for about 6 months and clarithromycin for sinusitis for about 3 weeks. He was treated aggressively with intravenous hydration, sodium bicarbonate, and hemodialysis. A muscle biopsy showed necrotizing myopathy secondary to a toxin. He continued to receive intermittent hemodialysis until he died from infectious complications 3 months after admission. 

Approximately 2 percent of patients have to discontinue taking these drugs due to side effects. The most common include the gastrointestinal tract (abdominal pain, diarrhea, constipation, and flatulence). Occasionally, patients may also develop muscle pain. Nevertheless, in summary, HMG-CoA inhibitors are the lipid-lowering drugs of first choice for treatment of most patients at risk for CAD. A long-term decrease in the rate of mortality or major coronary events has been documented with pravastatin, simvastatin, and lovastatin. 

Simvastatin, like other inhibitors of HMG-CoA reductase, occasionally causes myopathy manifested as muscle pain, tenderness or weakness with creatine kinase (CK) 10 times above the upper limit of normal (ULN). Myopathy sometimes takes the form of rhabdomyolysis with or without acute renal failure secondary to myoglobinuria, and very rare fatalities have occurred. 

The manufacturers of simvastatin note that in an ongoing unpublished clinical study, myopathy (clinically significant muscle pain with a creatinine kinase at least 10 times the upper limit of normal ) has been reported in 6% of patients receiving simvastatin 80 mg daily with amiodarone. " There is some evidence from reports to the US FDA that the concurrent use of simvastatin with amiodarone is associated with a higher incidence of muscle toxicity than pravastatin with amiodarone. They reported that the percentage of reports of muscle, liver, pancreas, and bone marrow toxicity associated with statins and involving concurrent amiodarone was 1% for simvastatin and 0.4% for pravastatin. ... 

A 68-year-old man who had been taking simvastatin 40 mg daily longterm without problem developed rhabdomyolysis (progressive muscle pain and weakness, tea-coloured urine, renal impairment, and a raised creatine phosphokinase) within 3 weeks of starting to take danazol 200 mg three times daily. He was given haemodialysis and subsequently recovered. 

These appear to be the only reports of this apparent interaction, but the pharmacokinetic basis of the interaction seems to be established. The US manufacturers of lovastatin suggest that the dose should not exceed 20 mg daily in the presence of danazol. Similarly the manufacturers of simvastatin suggest that the dose should not exceed 10 mg daily in the presence of danazol. It would seem prudent to reinforce the symptoms of myopathy and tell patients to report any unexplained muscle pain, tenderness or weakness. The authors of the lovastatin report point out that, as in this case, severe lovastatin muscle toxicity may be very slow to develop. See also muscle toxicity , (p.l086), for further guidance on monitoring, and risk factors for muscle toxicity. 

Podophyllotoxin In four patients concurrent administration of a podophyllotoxin-containing cytotoxic drug and simvastatin caused muscle pain, soreness, fatigue, or weakness, and in some cases rhabdomyolysis. These effects were attributed to competitive inhibition of CYP3A4-mediated metabolism of simvastatin [62" ]. 

Yuxingcao injection, 772 muscle cramps eplerenone, 344 immunoglobulins, intravenous, 516 phenol, 381 muscle fasdculations suxamethonium, 221 muscle/joint pains naltrexone, 168 muscle rigidity morphine, 160 muscle spasms fenoflbrate, 724 rosuvastatin, 724 simvastatin, 724 muscle vein thrombosis polidocanol, 795 muscle weakness botulinum toxins, 226-7 musculoskeletal pain codeine, 152 cyclobenzaprine, 227 methylnaltrexone, 152 mutagenicity lamivudine, 456 methylphenidate, 5-6... 

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