title: Myopathy induced by statin-ezetimibe combination: Evaluation of potential risk factors.
abstract: Although both atorvastatin and ezetimibe may cause myopathy, statin-induced myopathy is less likely at low doses, and ezetimibe is only rarely reported to induce myopathy. Also, ezetimibe is not usually known to potentiate statin-induced myopathy. We report a case of myalgia with elevated serum creatinine phosphokinase in a patient after 2 months of therapy with fixed dose combination of atorvastatin and ezetimibe (10 mg each). At the time of the event, patient was undertaking moderate physical exertion in the form of brisk walking for 30-40 min a day and was detected to have low serum Vitamin D levels. The adverse event resolved after stopping atorvastatin-ezetimibe combination therapy. Potential risk factors, such as physical exertion and Vitamin D deficiency, co-existent in dyslipidemic patients, may exacerbate myopathy potential of these drugs, and precipitate muscular symptoms even at a low-dose.
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Ballari
authors.initials: B
authors.lastname: Brahmachari
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Suparna
authors.initials: S
authors.lastname: Chatterjee
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000069059:Atorvastatin / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D000069438:Ezetimibe / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced* / Q000209:etiology; D005082:Physical Exertion / Q000502:physiology; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood
chemical_list: D000924:Anticholesteremic Agents; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D; D000069059:Atorvastatin; D000069438:Ezetimibe
keywords: Atorvastatin-ezetimibe combination therapy; Vitamin D deficiency; myopathy; physical exertion