title: Ranolazine-induced myopathy in a patient on chronic statin therapy.
abstract: We present a case demonstrating clinical, electrophysiological, serological, and radiological evidence of a myopathy induced by ranolazine, in a patient otherwise asymptomatic on chronic statin therapy. The patient developed proximal weakness, serum creatine kinase levels of 1875 U/L, electromyography with muscle membrane instability and small short-duration motor unit potentials, and magnetic resonance imaging evidence of muscle edema. The manifestations began within one week of initiation of ranolazine and improved within days after discontinuation. Ranolazine is a weak inhibitor of CYP3A4 known to increase the serum level of simvastatin and its active metabolite 2-fold. We postulate that the addition of ranolazine to a medical regimen that included atorvastatin induced a myoncecrotic myopathy.
authors.affiliation: Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD 20815, USA. dcorreapr@gmail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Correa
authors.forename: Mark
authors.initials: M
authors.lastname: Landau
mesh_terms: D000083:Acetanilides / Q000009:adverse effects* / Q000627:therapeutic use; D000369:Aged, 80 and over; D000069059:Atorvastatin; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006538:Heptanoic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D009135:Muscular Diseases / Q000139:chemically induced*; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D000069458:Ranolazine
chemical_list: D000083:Acetanilides; D004791:Enzyme Inhibitors; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010879:Piperazines; D011758:Pyrroles; D000069059:Atorvastatin; D000069458:Ranolazine