Reactions 1680, p62 - 2 Dec 2017 Muscle pain: case report A-56-year-old man developed muscle pain/complaints during treatment with atorvastatin, simvastatin and fluvastatin [routes, time to reactions onsets and outcomes not stated]. In March 2016, the man, with progressive angina pectoris (90% left anterior descending stenosis, one stent) presented to the clinic. He was started on treatment with atorvastatin 20 mg/day which induced muscle pain. Later on, atorvastatin treatment was switched to simvastatin 20 mg/day; however, he reported muscle complaints. His low density lipoprotein (LDL) cholesterol concentration was at 4.8 mmol/L (185 mg/dL), creatine kinase was at 3.52 mmol/L (normal range: less than 3.17) and lipoprotein (a) level was at 173 nmol/L, which prompted urgent lipid lowering drug therapy. Thus he was started on treatment with ezetimibe, which decreased LDL cholesterol to 3.6 mmol/L (138 mg/dL), without causing muscle pains. In order to achieve LDL cholesterol target value of 1.8 mmol/L (70 mg/dL) or better below 1.4 mmol/L (45 mg/dL), fluvastatin was started with a slow increase in the drug dose up to 60 mg/day; however, he developed non-severe muscle pain on fluvastatin treatment. His creatine kinase level was between 3.9 and 6.2 mmol/L, and LDL cholesterol was between 1.9 and 2.2 mmol/L (73-85 mg/dL). The man’s fluvastatin dose was decreased to 40 mg/day. As the target value for LDL cholesterol was not achieved, cholestyramine was administered and he was able to tolerate the drug at low dose. Author comment: "Statins have become an established option in lipid-lowering pharmacotherapy despite the fact that statin intolerance is fairly common. When muscle pains and/or an elevation of the creatine kinase appear, the dose must be lowered in patients with slight symptoms or stopped altogether if the symptoms are more severe." Fischer S, et al. Management of patients with statin intolerance. Atherosclerosis Supplements 30: 33-37, Nov 2017. Available from: URL: http://doi.org/10.1016/ j.atherosclerosissup.2017.05.013 - Germany 803284401 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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