Toxic and drug-induced myopathies.
Drugs used for therapeutic interventions either alone or in combination may sometimes cause unexpected toxicity to the muscles, resulting in a varying degree of symptomatology, from mild discomfort and inconvenience to permanent damage and disability. The clinician should suspect a toxic myopathy when a patient without a pre-existing muscle disease develops myalgia, fatigue, weakness or myoglobinuria, temporally connected to the administration of a drug or exposure to a myotoxic substance. This review provides an update on the drugs with well-documented myocytoxicity and cautions the clinicians to be alert for the potential toxicity of newly marketed drugs; highlights the clinical features and pathomechanisms of the induced muscle disease; and offers guidance on how best to treat and distinguish toxic myopathies from other acquired or hereditary muscle disorders. Practical issues regarding the diagnosis and management of statin-induced myopathies are emphasized. Myotoxicity resulting from direct insertion of transgenes to the muscle, an exciting new tool currently tested for treatment of muscular dystrophies, is also discussed.
Dalakas
M C
MC
Imperial College, London, Burlington Danes Building, Hammersmith Hospital Campus, Office E517, Du Cane Road, London W12 0NN, UK. m.dalakas@imperial.ac.uk
D019380:Anti-HIV Agents / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects; D004340:Drug Contamination; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects; D007273:Injections, Intramuscular / Q000009:adverse effects; D009135:Muscular Diseases / Q000139:chemically induced* / Q000473:pathology; D019966:Substance-Related Disorders
D019380:Anti-HIV Agents; D018501:Antirheumatic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors