Myopathy prevention/treatment

Musculoskeletal. Proximal myopathy and tendon rupture may occur. Osteoporosis develops insidiously leading to fractures of vertebrae, ribs, femora and feet. Pain and restriction of movement may occur months in advance of radiographic changes. A biphosphonate, with or without vitamin D, is useful for prevention and treatment. Growth in children is impaired. A vascular necrosis of bone (femoral heads) is a serious complication (at higher doses) it appears to be due to restriction of blood flow through bone capillaries. 

Local adverse effects from ICSs include oropharyngeal candidiasis and dysphonia that are dose-dependent. The dysphonia appears to be due to a local corticosteroid-induced myopathy of the vocal cords. The use of a spacer device can decrease oropharyngeal deposition and thus decrease the incidence and severity of local side effects. In infants who require delivery through a facemask, the parent should clean the nasal-perioral area with a damp cloth following each treatment to prevent topical candidal infections. 

However, in a major placebo-controlled trial of ezetimibe 10 mg/day + simvastatin 20 mg/day in 9270 patients with chronic kidney disease, the SHARP trial has shown a significant 17% reduction in major cardiovascular events [6 ]. Although treatment did not prevent progression of renal disease nor reduce total mortality, it showed that it is safe to treat patients with chronic kidney disease with these two drugs in combination. Myopathy did not occur more frequently than among controls. 

Koumis, T, J.P Nathan, J.M. Rosenberg, and L.A. Cicero, Strategies for the prevention and treatment of statin-induced myopathy is there a role for ubiquinone supplementation Am J Health Syst Pharm, 61 515-519, 2004. 

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