Franc S, Bruckert E, Giral P, Turpin G
Unité d'exploration métabolique pour la prévention des maladies cardio-vasculaires, Hôpital Pitié-Salpêtrière, Paris.
Presse Med. 1997 Dec 6;26(38):1855-8.
Lipid lowering drugs (fibrates and statins) are generally well tolerated and side effects, mainly hepatic and muscular disorders are rare. However, when they occur, muscular disorders may be severe, leading to rhabdomyolysis. We report here four cases of rhabdomyolysis in patients given lipid lowering drugs and who had pre-existing myopathy.
The four patients complained of muscle pain after treatment with niacin, HMGCoA inhibitors, as well as fibrates. The myopathy was not recognized at the time of prescription in three cases. Myopathy resolved rapidly upon discontinuation of the drugs and none of the patients developed renal failure.
This is the first report of rhabdyomyosis induced by lipid lowering drugs in patients with pre-existing myopathy. Drug induced myopathy is a known complication of lipid lowering drugs either alone or in patients with other conditions such as renal failure, immunosuppressive therapy for cardiac transplantation, or in case of combination regimens. Such a side effect without concomitant disease has not been reported previously in patients with congenital myopathy. Cholestyramine is the drug of choice for these patients. Our observations suggest that the rhabdomyolysis provoked by lipid lowering drugs may be favored by pre-existing myopathy.
降脂药物（贝特类和他汀类）通常耐受性良好，副作用主要为肝脏和肌肉疾病，较为罕见。然而，一旦发生，肌肉疾病可能较为严重，导致横纹肌溶解。我们在此报告4例服用降脂药物且原有肌病的患者发生横纹肌溶解的病例。
这4例患者在用烟酸、HMGCoA抑制剂以及贝特类药物治疗后均出现肌肉疼痛。3例患者在处方用药时未被识别出患有肌病。停药后肌病迅速缓解，且无一例患者发展为肾衰竭。
这是首例关于原有肌病的患者由降脂药物诱发横纹肌溶解的报告。药物性肌病是降脂药物已知的一种并发症，无论是单独使用降脂药物，还是在患有其他疾病（如肾衰竭、心脏移植的免疫抑制治疗）的患者中，或者在联合用药方案中。先天性肌病患者中此前尚未报告过无伴随疾病的这种副作用。考来烯胺是这些患者的首选药物。我们的观察结果表明，原有肌病可能会促使降脂药物诱发横纹肌溶解。
