Statin-Induced Neuropathic Pain: A Case Report
Abstract
The most reported form of statin induced pain is myalgia, conversely peripheral neuropathy is a rare side effect. We report a patient who received rosuvastatin for hypercholesterolemia and experienced episodes of pain in both hands during the night. Rosuvastatin was stopped and atorvastatin was replaced. Re-introduction with another statin resulted in a more severe form of the similar adverse effect after 4 months. This is a rare adverse effect of a extensively prescribed class of drug. Physicians should be aware of the possibility of peripheral neuropathy symptoms in patients on statin therapy.
1. Backonja M-M, Stacey B. Neuropathic pain symptoms relative to overall pain rating. The Journal of Pain. 2004;5(9):491-7.
2. Zhang L, Zhang ZG, Liu XS, Hozeska-Solgot A, Chopp M. The PI3K/Akt pathway mediates the neuroprotective effect of atorvastatin in extending thrombolytic therapy after embolic stroke in the rat. Arterioscler Thromb Vasc Biol. 2007;27(11):2470-5.
3. Auer J, Sinzinger H, Franklin B, Berent R. Muscle-and skeletal-related side-effects of statins: tip of the iceberg? European journal of preventive cardiology. 2016;23(1):88-110.
4. Chemello RML, Benvegnú AM, Dallazem LND, Chemello D. Aggressive and fatal statin-induced dermatomyositis: a case report. Oxford medical case reports. 2017;2017(12):omx063.
5. Lo Y, Leoh T, Loh L, Tan C. Statin therapy and small fibre neuropathy: a serial electrophysiological study. J Neurol Sci. 2003;208(1):105-8.
6. Weimer LH, Sachdev N. Update on medication-induced peripheral neuropathy. Curr Neurol Neurosci Rep. 2009;9(1):69.
7. Chong PH, Boskovich A, Stevkovic N, Bartt RE. Statin‐associated peripheral neuropathy: review of the literature. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2004;24(9):1194-203.
8. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res (Hoboken). 2011;63(S11):S240-S52.
9. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts E, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.
10. Tierney EF, Thurman DJ, Beckles GL, Cadwell BL. Association of statin use with peripheral neuropathy in the US population 40 years of age or older (美国 40 岁及以上人群的他汀使用情况与周围神经病变的关系). J Diabetes. 2013;5(2):207-15.
11. Gaist D, Jeppesen U, Andersen M, Rodriguez LG, Hallas J, Sindrup SH. Statins and risk of polyneuropathy A case-control study. Neurology. 2002;58(9):1333-7.
12. Gaist D, Rodríguez LAG, Huerta C, Hallas J, Sindrup SH. Are users of lipid-lowering drugs at increased risk of peripheral neuropathy? Eur J Clin Pharmacol. 2001;56(12):931-3.
13. Corrao G, Zambon A, Bertù L, Botteri E, Leoni O, Contiero P. Lipid lowering drugs prescription and the risk of peripheral neuropathy: an exploratory case-control study using automated databases. J Epidemiol Community Health. 2004;58(12):1047-51.
14. Beltowski J, Wojcicka G, Jamroz-Wisniewska A. Adverse effects of statins-mechanisms and consequences. Current drug safety. 2009;4(3):209-28.
15. Jacobs MB. HMG-CoA reductase inhibitor therapy and peripheral neuropathy. Ann Intern Med. 1994;120(11):970-.
16. Ahmad S. Lovastatin and peripheral neuropathy. Am Heart J. 1995;130(6):1321.
17. Phan T, McLeod J, Pollard J, Peiris O, Rohan A, Halpern J. Peripheral neuropathy associated with simvastatin. J Neurol Neurosurg Psychiatry. 1995;58(5):625-8.
18. Ziajka PE, Wehmeier T. Peripheral neuropathy and lipid-lowering therapy. South Med J. 1998;91(7):667-8.
19. Jeppesen U, Gaist D, Smith T, Sindrup S. Statins and peripheral neuropathy. Eur J Clin Pharmacol. 1999;54(11):835-8.
20. Lovastatin 5-year safety and efficacy study. Arch Intern Med. 1993;153(9):1079-87.
21. West B, Williams CM, Jilbert E, James AM, Haines TP. Statin use and peripheral sensory perception: a pilot study. Somatosens Mot Res. 2014;31(2):57-61.
22. Anderson JL, Muhlestein JB, Bair TL, Morris S, Weaver AN, Lappé DL, et al. Do statins increase the risk of idiopathic polyneuropathy? Am J Cardiol. 2005;95(9):1097-9.
23. Ii M, Nishimura H, Kusano KF, Qin G, Yoon Y-s, Wecker A, et al. Neuronal nitric oxide synthase mediates statin-induced restoration of vasa nervorum and reversal of diabetic neuropathy. Circulation. 2005;112(1):93-102.
24. Mancini GJ, Baker S, Bergeron J, Fitchett D, Frohlich J, Genest J, et al. Diagnosis, prevention, and management of statin adverse effects and intolerance: proceedings of a Canadian Working Group Consensus Conference. Can J Cardiol. 2011;27(5):635-62.
25. Stein EA, Ballantyne CM, Windler E, Sirnes PA, Sussekov A, Yigit Z, et al. Efficacy and tolerability of fluvastatin XL 80 mg alone, ezetimibe alone, and the combination of fluvastatin XL 80 mg with ezetimibe in patients with a history of muscle-related side effects with other statins. Am J Cardiol. 2008;101(4):490-6.
26. Zema MJ. Colesevelam HCl and ezetimibe combination therapy provides effective lipid-lowering in difficult-to-treat patients with hypercholesterolemia. Am J Ther. 2005;12(4):306-10.
27. Berge K, Canner P, Group CDPR. Coronary drug project: experience with niacin. Eur J Clin Pharmacol. 1991;40(1):S49-S51.
28. Insull Jr W. Clinical utility of bile acid sequestrants in the treatment of dyslipidemia: a scientific review. South Med J. 2006;99(3):257-74.
29. Jenkins DJ, Leeds AR, Gassull MA, Cochet B, ALBERTI KGM. Decrease in postprandial insulin and glucose concentrations by guar and pectin. Ann Intern Med. 1977;86(1):20-3.
30. Halbert SC, French B, Gordon RY, Farrar JT, Schmitz K, Morris PB, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol. 2010;105(2):198-204.
2. Zhang L, Zhang ZG, Liu XS, Hozeska-Solgot A, Chopp M. The PI3K/Akt pathway mediates the neuroprotective effect of atorvastatin in extending thrombolytic therapy after embolic stroke in the rat. Arterioscler Thromb Vasc Biol. 2007;27(11):2470-5.
3. Auer J, Sinzinger H, Franklin B, Berent R. Muscle-and skeletal-related side-effects of statins: tip of the iceberg? European journal of preventive cardiology. 2016;23(1):88-110.
4. Chemello RML, Benvegnú AM, Dallazem LND, Chemello D. Aggressive and fatal statin-induced dermatomyositis: a case report. Oxford medical case reports. 2017;2017(12):omx063.
5. Lo Y, Leoh T, Loh L, Tan C. Statin therapy and small fibre neuropathy: a serial electrophysiological study. J Neurol Sci. 2003;208(1):105-8.
6. Weimer LH, Sachdev N. Update on medication-induced peripheral neuropathy. Curr Neurol Neurosci Rep. 2009;9(1):69.
7. Chong PH, Boskovich A, Stevkovic N, Bartt RE. Statin‐associated peripheral neuropathy: review of the literature. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2004;24(9):1194-203.
8. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res (Hoboken). 2011;63(S11):S240-S52.
9. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts E, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.
10. Tierney EF, Thurman DJ, Beckles GL, Cadwell BL. Association of statin use with peripheral neuropathy in the US population 40 years of age or older (美国 40 岁及以上人群的他汀使用情况与周围神经病变的关系). J Diabetes. 2013;5(2):207-15.
11. Gaist D, Jeppesen U, Andersen M, Rodriguez LG, Hallas J, Sindrup SH. Statins and risk of polyneuropathy A case-control study. Neurology. 2002;58(9):1333-7.
12. Gaist D, Rodríguez LAG, Huerta C, Hallas J, Sindrup SH. Are users of lipid-lowering drugs at increased risk of peripheral neuropathy? Eur J Clin Pharmacol. 2001;56(12):931-3.
13. Corrao G, Zambon A, Bertù L, Botteri E, Leoni O, Contiero P. Lipid lowering drugs prescription and the risk of peripheral neuropathy: an exploratory case-control study using automated databases. J Epidemiol Community Health. 2004;58(12):1047-51.
14. Beltowski J, Wojcicka G, Jamroz-Wisniewska A. Adverse effects of statins-mechanisms and consequences. Current drug safety. 2009;4(3):209-28.
15. Jacobs MB. HMG-CoA reductase inhibitor therapy and peripheral neuropathy. Ann Intern Med. 1994;120(11):970-.
16. Ahmad S. Lovastatin and peripheral neuropathy. Am Heart J. 1995;130(6):1321.
17. Phan T, McLeod J, Pollard J, Peiris O, Rohan A, Halpern J. Peripheral neuropathy associated with simvastatin. J Neurol Neurosurg Psychiatry. 1995;58(5):625-8.
18. Ziajka PE, Wehmeier T. Peripheral neuropathy and lipid-lowering therapy. South Med J. 1998;91(7):667-8.
19. Jeppesen U, Gaist D, Smith T, Sindrup S. Statins and peripheral neuropathy. Eur J Clin Pharmacol. 1999;54(11):835-8.
20. Lovastatin 5-year safety and efficacy study. Arch Intern Med. 1993;153(9):1079-87.
21. West B, Williams CM, Jilbert E, James AM, Haines TP. Statin use and peripheral sensory perception: a pilot study. Somatosens Mot Res. 2014;31(2):57-61.
22. Anderson JL, Muhlestein JB, Bair TL, Morris S, Weaver AN, Lappé DL, et al. Do statins increase the risk of idiopathic polyneuropathy? Am J Cardiol. 2005;95(9):1097-9.
23. Ii M, Nishimura H, Kusano KF, Qin G, Yoon Y-s, Wecker A, et al. Neuronal nitric oxide synthase mediates statin-induced restoration of vasa nervorum and reversal of diabetic neuropathy. Circulation. 2005;112(1):93-102.
24. Mancini GJ, Baker S, Bergeron J, Fitchett D, Frohlich J, Genest J, et al. Diagnosis, prevention, and management of statin adverse effects and intolerance: proceedings of a Canadian Working Group Consensus Conference. Can J Cardiol. 2011;27(5):635-62.
25. Stein EA, Ballantyne CM, Windler E, Sirnes PA, Sussekov A, Yigit Z, et al. Efficacy and tolerability of fluvastatin XL 80 mg alone, ezetimibe alone, and the combination of fluvastatin XL 80 mg with ezetimibe in patients with a history of muscle-related side effects with other statins. Am J Cardiol. 2008;101(4):490-6.
26. Zema MJ. Colesevelam HCl and ezetimibe combination therapy provides effective lipid-lowering in difficult-to-treat patients with hypercholesterolemia. Am J Ther. 2005;12(4):306-10.
27. Berge K, Canner P, Group CDPR. Coronary drug project: experience with niacin. Eur J Clin Pharmacol. 1991;40(1):S49-S51.
28. Insull Jr W. Clinical utility of bile acid sequestrants in the treatment of dyslipidemia: a scientific review. South Med J. 2006;99(3):257-74.
29. Jenkins DJ, Leeds AR, Gassull MA, Cochet B, ALBERTI KGM. Decrease in postprandial insulin and glucose concentrations by guar and pectin. Ann Intern Med. 1977;86(1):20-3.
30. Halbert SC, French B, Gordon RY, Farrar JT, Schmitz K, Morris PB, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol. 2010;105(2):198-204.
| Files | ||
| Issue | Vol 7, No 4 (Autumn 2019) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/jpc.v7i4.2382 | |
| Keywords | ||
| atorvastatin rosuvastatin neuropathic pain Peripheral Neuropathy | ||
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How to Cite
1.
Vaziri N, Mofakham H, Fahimi F. Statin-Induced Neuropathic Pain: A Case Report. J Pharm Care. 2020;7(4):120-122.
