Statins, side effects

HMG-CoA reductase inhibitors (statins). This effect has been suggested to account for some of the side effects of statins like myositis or rhabdomyolysis. 

Abdominal symptoms including changes in bowel function, rash, and disturbances of sleep have been reported, but in general statins are remarkably free of side effects. Thus, in the large clinical trials comprising... 

The effect of a statin is usually determined by measuring fasting plasma lipids and lipoproteins after 4-6 weeks of treatment. Liver enzymes and eventually creatine kinase (in case of myositis liver enzymes are usually also elevated) are measured simultaneously to exclude side effects related to liver and muscles. After the treatment goal has been reached, blood sampling is usually performed 1-2 times a year. 

Rhabdomyolysis is disintegration and death of muscle cells (myocytes). It is an important but rare side effect of treatment with statins. 

Atorvastatin 1 0, 20, 40, 80 mg tablets 1 0 to 80 mg once daily (at any time of day) Most frequent side effects are constipation, abdominal pain, diarrhea, dyspepsia, and nausea. Statins... 

Assess LC s risk for statin-induced side effects. 

Compared with monotherapy, combination therapy is relatively unstudied in terms of the effects on CHD event reduction and may reduce patient compliance through increased side effects and increased costs. When used appropriately and with proper precautions, however, they are effective in normalizing lipid abnormalities, particularly in patients who cannot tolerate adequate doses of statin therapy for more severe forms of dyslipidemia. 

Typically, statins are the medications of choice to treat high LDL cholesterol because of their ability to substantially reduce LDL cholesterol, ability to reduce morbidity and mortality from atherosclerotic disease, convenient once-daily dosing, and low risk of side effects. 

Garlic s proven mechanisms of action include (a) inhibition of platelet function, (b) increased levels of two antioxidant enzymes, catalase and glutathione peroxidase, and (c) inhibition of thiol enzymes such as coenzyme A and HMG coenzyme A reductase. Garlic s anti-hyperlipidemic effects are believed to be in part due to the HMG coenzyme A reductase inhibition since prescription medications for hyperlipidemia have that mechanism of action (statins). It is unknown whether garlic would have the same drug interactions, side effects, and need for precautions as the statins. 

As indicated in Table 1, statins, which block cholesterol biosynthesis by inhibition of hepatic HMGCoA reductase, have been used extensively to reduce LDL-C levels. At most therapeutic doses, statins marginally increase HDL levels by 5-10% [3,16]. The HDL elevation observed with statins has been highly variable and not easily extrapolated from the effects on LDL. A recent study (STELLAR) demonstrated increased HDL elevation with the use of rosuvastatin compared to simvastatin, pravastatin or atorvastatin (10% vs. 2-6%) [16,24], Although the mechanism of HDL elevation by statins is not clearly understood, it is proposed that statins enhance hepatic apoA-I synthesis [25] and decrease apoB-containing lipoproteins [26]. A number of clinical trials have demonstrated that statins reduce the risk of major coronary events. However, it is not clear if the statin-induced rise in HDL levels is an independent contributor to the reduced risk of coronary events. The observed small increase in HDL and adverse side effect profile related to liver function abnormalities and muscle toxicity limits the use of statins as monotherapy for HDL elevation [27],... 

Rhabdomyolysis is the destruction of skeletal muscle tissues and may be associated with lipid-regulating drugs such as the fibrates and the statins. The risk of this side-effect is increased in patients with renal impairment and with hypothyroidism. Rhabdomyolysis may also occur with nicotinic acid, the antipsychotic aripiprazole, and the anaesthetic propofol. 

Skeletal muscle myopathy often leads to release of CK of the MM type. Rhabdomyolysis Is one of the major side effects of treatment with the cholesterol-lowering drugs the statins. 

Base statin seiection on iipid-lowering prowess, cost, side effects, and avaiiabiiity of mortality reduction studies... 

An article in the New England Journal of Medicine reports that 24 patients taking fen-phen, a combination of two weight-reduction drugs, have an unusual form of heart disease involving abnormalities in the heart valves. The FDA approves Baycol, an anticholesterol statin drug made by Bayer. It costs less than competitors but turns out to have a rare but serious side effect that destroys muscle tissue. 

Dujovne CA. Side effects of statins hepatitis versus transaminitis -myositis versus CPKitis . Am J Cardiol 2002 89(12) 1411-3. 

The weight of evidence supports the conclusion that the more expressed inhibition of HMG-CoA reductase by a higher statin blood level reduces the concentrations of other essential products, primarily of isoprenylated proteins and possibly ubiquinone, synthetized downstream from mevalonic acid within the peripheral cells. In parallel, it was also recognized that statins exert pleiotropic effects in various cells far beyond the originally described inhibition of hepatic cholesterol synthesis. All of these effects are considered to be class-specific for the statins. It is important to emphasize that the frequency of untoward side effects observed with the various statins can be related to their potency, the number of metabolic inter-... 

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