title: The causes of drug-induced muscle toxicity.
abstract: OBJECTIVE
  Clinically identified myopathies are frequently a consequence of medication toxicities. However, recognizing drug-induced myopathies is sometimes difficult. Developing a greater understanding of the underlying mechanisms of drug-induced muscle toxicity will promote enhanced awareness and recognition, and improved management of these syndromes.
  
  
  RESULTS
  The adverse impact of certain drugs on muscle metabolism, muscle cell atrophy, and myocyte apoptosis is increasingly clear. Glucocorticoids impair glucose handling and directly promote protein catabolism. Statins impair mitochondrial function and alter intracellular signaling proteins, which can lead to myocyte apoptosis. Alternatively, statins can induce an autoimmune necrotizing myositis. Several medications impair autophagy, thus limiting access to the needed glycogen stores.
  
  
  CONCLUSIONS
  This review provides an overview of the main underlying mechanisms of drug-induced myopathies. These myopathies will most often be related to a drug's ability to alter metabolism and protein balance, induce necrosis, or impair autophagy.
authors.affiliation: aDivision of Rheumatology, Department of Medicine, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire bDivision of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York, USA *Jonathan D. Jones and Hannah L. Kirsch contributed equally to the writing of this article.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Jones
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Kirsch
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wortmann
authors.forename: Michael H
authors.initials: MH
authors.lastname: Pillinger
mesh_terms: D017209:Apoptosis / Q000187:drug effects; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D005938:Glucocorticoids / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000473:pathology; D009135:Muscular Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology
chemical_list: D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors