The Pharmaceutical Journal Vol 267 No 7175 p733-738
24 November 2001

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Encourage statin patients to report muscle weakness

Patients taking statins should be educated about the possibility of myopathies and encouraged to report any unexplained muscle pains or weakness, say researchers.

In a commentary published this month in the Journal of Clinical Pharmacy and Therapeutics, Dr Nigel Langford and Dr Martin Kendall, department of medicine, University of Birmingham, conclude that pravastatin (Lipostat) is safer than other statins in terms of risk of rhabdomylosis (muscle weakness) because it is least likely to undergo a pharmacokinetic interaction. They point out that pravastatin differs markedly from other statins in that it is not metabolised by cytochrome P450 enzymes. However, they add that all statins have the potential to cause rhabdomylosis and say that predicting responses to statins is complicated because they have different bioavailabilities.

They comment that cerivastatin (Lipobay), which was withdrawn earlier this year because of its interaction with gemfibrozil (PJ, 11 August, p181 and 18 August, p222), has two routes of metabolism (CYP3A4 and CYP2C8) and so is theoretically less likely to undergo drug interactions than statins solely metabolised by the CYP3A4 pathway. They also suggest that gemfibrozil might have a direct toxic action on muscle cells in patients with an unrecognised predisposition to myopathy.

Primary care professionals should recognise the problem, monitor it appropriately and use the yellow card system, should cases occur, they conclude (2001;26:391).

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