Experience over recent years has suggested that statins (drugs to lower cholesterol) may affect muscles in people who have previously been affected by polio. These statin effects include either muscle weakness, cramps, aches & pains or stiffness.
Below are relevant excerpts from the published
warnings to doctors in an Australian Medical Journal in August 2003 of
muscle damage potential for patients on statins.
| STATINS and MUSCLE DAMAGE by Dr Ian Hamilton-Craig - Cardiologist Adelaide |
| "Muscle damage is an uncommon but important adverse
reaction to statins. Patients may experience a range of musculoskeletal
symptoms varying from mild aching to severe pain, usually in proximal
(nearer to the spine) muscle groups. Muscle stiffness and weakness
also occur to a varying degree. The concentration of creatine
kinase(CK) in the blood is usually increased.
Mild symptoms myalgia ie (muscle pain) are usually associated with minimal elevation of CK concentrations The most serious type of muscle damage ie rhabdomolysis (muscle wastage - further muscle loss, generalised or in particular areas- that can occur with concurrent kidney damage also possible), occurs only rarely but is important to recognise as it may be fatal. The patient often has severe muscle pain, stiffness and weakness with constitutional symptoms of fever and malaise. Their urine may be dark and of small volume because of myoglobinuria and impaired renal function. Stopping the drug is the only specific treatment
for muscle damage.
The symptoms usually resolve rapidly (within a
few days to weeks) after withdrawal of statin therapy. Combination
with nicotinic acid (the B3 that causes flushing - not generally available
without a script in Australia) and gemfibrozil (eg Lopid - ie other cholesterol
drugs) can also result in muscle damage.
|
Recently, histologically-confirmed (under a microscope) muscle damage has been found in 4 patients with normal CK concentrations. Muscle damage was suspected because of weakness and/or severe myalgia, which responded to statin withdrawal and recurred on statin rechallenge. The prevalence of muscle damage in patients with normal CK concentrations is unknown. The disorder must be seriously considered in any patient taking a statin who complains of muscle aches and pains and/or weakness in spite of normal CK concentrations. A trial of statin withdrawal should be considered. Baseline renal, thyroid and hepatic function tests and CK concentrations are recommended before starting statin therapy. Muscle symptoms after 6 - 12 weeks and at each follow-up visit. If muscle symptoms occur the CK should be measured. This advice was published before the finding that muscle damage can occur with normal CK concentrations. So the recommendations regarding statin withdrawal may be too conservative. Clinicians should be aware of the need for vigilance
in the monitoring of symptoms. Patients should be advised to report any
symptoms at the earliest stage in order to prevent the rare, but more serious,
muscle complications of statin therapy."
|