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HMG CoA reductase‐inhibitor‐related myopathy and the influence of drug interactions

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We report four cases of rhabdomyolysis and severe, disabling myopathy associated with HMG CoA reductase‐inhibitor therapy. Patient 1 developed symptoms following the addition of roxithromycin to combination lipid‐lowering therapy with simvastatin and gemfibrozil. Patients 2 and 3 became symptomatic after developing acute on chronic renal impairment while taking simvastatin. The muscle biopsy of patient 3 revealed a necrotizing myopathy and the presence of inclusion bodies. Patient 4 developed symptoms within 4 weeks of starting cerivastatin monotherapy. The four cases illustrate the importance of considering the potential for drug interactions and making appropriate dosage adjustments for renal insufficiency in patients receiving HMG CoA reductase therapy. (Intern Med J 2002; 32: 486−490)
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Keywords: HMG CoA reductase inhibitors; renal impairment; rhabdomyolysis; ­myopathy

Document Type: Research Article

Affiliations: 1: Departments of Aged Care 2: Neurology 3: Department of Neurology, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia 4: Rheumatology and 5: Cardiology, Bankstown-Lidcombe Hospital and

Publication date: 2002-09-01

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