Drug-induced myopathies

Curr Opin Neurol. 2008 Oct;21(5):590-5. doi: 10.1097/WCO.0b013e32830e2774.

Abstract

Purpose of review: Drug-induced muscle disorders are important causes of morbidity, but the risk-benefit profile of the incriminated drugs must be put into perspective. This review highlights some recent advances on statin-induced and antiretroviral drug-induced myopathies and calls attention to some less familiar myotoxic disorders.

Recent findings: In statin myopathy, reduction of coenzyme Q has been discussed as a key mechanism. However, data on coenzyme Q concentration and mitochondrial dysfunction in muscle of these patients are not conclusive. The first two controlled trials on coenzyme Q supplementation in statin myopathy have yielded contradictory results and do not support a routine supplementation. In human immunodeficiency virus infection, the advent of highly active antiretroviral therapy has led to a shift from virus-related to drug-induced morbidity. The knowledge of these distinct syndromes allows rational management. In addition, an omnium-gatherum is presented with recent findings on drug-induced dermatomyositis, tendinopathy, rhabdomyolysis, and local myotoxicity. These latter topics are intended to direct attention to less familiar but still clinically relevant myotoxic events.

Summary: Statin myotoxicity may be prevented in many cases by anticipation of drug-drug interactions. On the contrary, undue withdrawal of statins owing to minor myalgias should be avoided. A large and appropriately powered trial is required to finally determine whether supplementation of coenzyme Q can mitigate statin myopathy. The identification of individual genetic risk factors for myotoxicity is a key challenge for future pharmacogenomic research.

Publication types

  • Review

MeSH terms

  • Antiretroviral Therapy, Highly Active / adverse effects
  • Dermatomyositis / chemically induced
  • Dermatomyositis / pathology
  • Dermatomyositis / physiopathology
  • Fluoroquinolones / adverse effects
  • Fluoroquinolones / pharmacology
  • Genetic Predisposition to Disease
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / pharmacology
  • Muscle, Skeletal / drug effects
  • Muscle, Skeletal / pathology
  • Muscle, Skeletal / physiopathology
  • Muscular Diseases / chemically induced*
  • Muscular Diseases / genetics
  • Muscular Diseases / pathology
  • Muscular Diseases / physiopathology

Substances

  • Fluoroquinolones
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors