title: Severe muscle symptoms with lipid-lowering agents may be confused with neurogenic claudication associated with spinal canal stenosis.
abstract: BACKGROUND
  Screening of the WHO global individual case safety report database (VigiBase) has recently identified case reports with HMG CoA reductase inhibitors and muscle symptoms co-reported with spinal stenosis. In some reports spinal stenosis appears to have been listed as a coincidental finding.
  
  
  OBJECTIVE
  To assess reports with sufficient information to ascertain if they suggested that there may have been diagnostic confusion between muscle symptoms attributable to HMG CoA reductase inhibitors with or without ezetimibe and symptoms of spinal stenosis.
  
  
  METHODS
  Reports were examined for patient demographics, past history, clinical and investigational findings, co-prescribed medicines and outcomes.
  
  
  RESULTS
  Three case histories recorded details suggestive of diagnostic confusion between severe and disabling muscle symptoms affecting the lower limbs attributable to an HMG CoA reductase inhibitor with and without ezetimbe and symptoms of neurogenic claudication due to spinal stenosis. The statins were not discontinued promptly leading to prolonged morbidity. Serum creatine kinase levels (CK) were normal in two patients and not recorded for the third.
  
  
  CONCLUSIONS
  The reports include two safety issues, firstly the need to consider HMG CoA reductase inhibitors as a cause of severe lower limb muscle symptoms even in the presence of spinal stenosis and normal CK levels and the second, the need to measure serum creatine kinase when these symptoms occur to detect progression of myopathy and potentially serious outcomes.
authors.affiliation: Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand. ruth.savage@otago.ac.nz
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Savage
authors.forename: Kristina
authors.initials: K
authors.lastname: Star
authors.forename: Richard
authors.initials: R
authors.lastname: Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007383:Intermittent Claudication / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects*; D009135:Muscular Diseases / Q000175:diagnosis*; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors