Ezetimibe-associated myopathy in monotherapy and in combination with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor.
Two cases of myopathy associated with ezetimibe are reported. In the first case, a woman on ezetimibe monotherapy presented with muscle pain and an elevated concentration of creatine kinase (CK) on two occasions, with ezetimibe 10 mg and with ezetimibe 5 mg after a washout period. The recurrence of muscle pain after washout and the CK increase both supported the hypothesis that ezetimibe alone can be linked to myalgia. In the second case, a man had been treated with atorvastatin, and ezetimibe 10 mg was added to improve his lipid profile. Two months later, the patient complained of muscle pain and a CK increase was noted. The appearance of symptoms when adding ezetimibe to atorvastatin supports a potential pharmacokinetic and/or a pharmacodynamic interaction between these two drugs. These cases suggest that ezetimibe monotherapy as well as ezetimibe associated with the use of a statin may induce myalgia. The mechanism by which ezetimibe could cause muscle pain is not known.
Simard
Chantale
C
Centre de recherche, Hôpital Laval, Université Laval, Sainte-Foy, Quebéc, Canada. chantale.simard@pha.ulaval.ca
Poirier
Paul
P
D000328:Adult; D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D001384:Azetidines / Q000009:adverse effects* / Q000493:pharmacokinetics; D003402:Creatine Kinase / Q000378:metabolism; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009135:Muscular Diseases / Q000139:chemically induced*; D010146:Pain / Q000139:chemically induced
D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003402:Creatine Kinase; D000069438:Ezetimibe