Cholesterol-lowering drugs can lead to muscle problems

DEAR DR. DONOHUE: I am a 70-year-old retired surgeon who has taken Lipitor for the past five years. I also am a serious slalom water-skier. This sport puts great stress on muscles. While skiing, I suffered a silent tear of the hamstring muscle that became painful several hours later. A large hematoma formed. I know that a complication of Lipitor is muscle weakness, and I discontinued it immediately. Is the mechanism of muscle weakness known? Do the muscles strengthen again in time, and how long does that take? I want to return to skiing. — B.W. A: Statin drugs (Lipitor, atorvastatin; Zocor, simvastatin; Pravachol, pravastatin; Crestor, rosuvastatin; Lescol, fluvastatin; and Mevacor, lovastatin) are the most effective cholesterol-lowering drugs available. It seems that just about everyone over 50 takes one of them.

They can cause muscle problems. Myalgia is one of those problems. It is muscle inflammation with tenderness and pain. Myopathy is another problem. It’s muscle achiness and weakness. And the third, and most serious, complication is rhabdomyolysis, muscle disintegration. This happens very rarely, to about one in 10,000 users. Lowering the dose, switching to another statin or changing to a different medicine is usually all the treatment necessary, except for rhabdomyolysis.

The exact mechanism that causes statin-induced muscle trouble hasn’t been clearly demonstrated. It’s postulated that it might be due to a lessening of the production of mevalonate, a body material critical to muscle health.

People simultaneously taking drugs like gemfibrozil, some anti-fungals, macrolide antibiotics like erythromycin, the heart medicine digoxin and the blood thinner Coumadin are more likely to develop muscle complications with statin drugs.

Almost all recover from this side effect without any permanent damage. Recovery might take a month or two. Rhabdomyolysis, however, can be deadly. You’ll ski again. I’ll wave as you pass by.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at PO Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

c. North America Syndicate