Original Article

Atorvastatin-Induced Myalgia in Iranian Patients: A Hospital-Based Study to Determine the Prevalence and Associated Risk Factors


Backgrounds: Statins are associated with several muscle complaints, such as: myositis, myalgia, muscle weakness, muscle spasms and rhabdomyolysis. Age, race, gender, dose of statin, concomitant medications, concomitant disorders and genetics have been reported as the most important risk factor for statin-induced myalgia. The aim of this study was to determine the prevalence and associated risk factors of atorvastatin-induced myalgia in hospitalized patients in Tehran, Iran. Methods: In this cross sectional study, a questionnaire was developed by expert panel opinions. The questionnaire was included various items regarding demographic data and myalgia evaluation factors. Seven hundred patients were included in the study and necessary data were gathered. Finally, the data were analyzed and a statistical model was designed to predict the myalgia risk factors. Results: The rate of myalgia was 44.3% among studied patients. By developing a multivariate logistic model, female gender (OR= 0.47, P-value<0.001) was one of the most important factors in myalgia occurrence. Conclusion: The results of this study suggest that gender, age, atorvastatin dose, duration of atorvastatin usage and presence of myotoxic disease are the main predictors of myalgia in Iranian population. Hence, the findings of this study can be considered to predict the myalgia incidence risk in Iranian population.

1. Tobert JA. Lovastatin and beyond: the history of the HMG-CoA reductase inhibitors. Nat Rev Drug Discov 2003;2(7):517-26.
2. Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006;48(3):438-45.
3. Thompson PD, Clarkson P, Karas RH. Statin-associated myopathy. JAMA 2003; 289(13):1681-90.
4. Chatzizisis YS, Koskinas KC, Misirli G, Vaklavas C, Hatzitolios A, Giannoglou GD. Risk factors and drug interactions predisposing to statin-induced myopathy: implications for risk assessment, prevention and treatment. Drug Saf 2010;33(3):171-87.
5. Feng Q, Wilke RA, Baye TM. Individualized risk for statin-induced myopathy: Current knowledge, emerging challenges, and potential solutions. Pharmacogenomics 2012;13(5):579-94.
6. Frudakis TN, Thomas MJ, Ginjupalli SN, Handelin B, Gabriel R, Gomez HJ. CYP2D6*4 polymorphism is associated with statin-induced muscle effects. Pharmacogenetics Genomics 2007;17(9):695-707.
7. Arrigoni E, Del Re M, Fidilio L, Fogli S, Danesi R, Di Paolo A. Pharmacogenetic Foundations of Therapeutic Efficacy and Adverse Events of Statins. Int J Mol Sci 2017;18(1):104.
8. Abd TT, Jacobson TA. Statin-induced myopathy: a review and update. Expert Opin Drug Saf 2011;10(3):373-87.
9. Rosenson RS, Baker SK, Jacobson TA, Kopecky SL, Parker BA, The National Lipid Association's Muscle Safety Expert Panel. An assessment by the Statin Muscle Safety Task Force: 2014 update. J Clin Lipidol 2014;8(3 Suppl):S58-71.
10. Mashayekhi SO, Ghandforoush Sattari M, Baghdadchi ME, Kheyri M. Patients' report of statins use and side-effects in a sample of hospitalized cardiac patients in the Islamic Republic of Iran. Eastern MediterraneanHealth Journal 2011;7(5):460-464.
11. Riaz H, Khan AR, Khan MS, et al. Meta-analysis of Placebo-Controlled Randomized Controlled Trials on the Prevalence of Statin Intolerance. Am J Cardiol 2017;120(5):774-81.
12. Sadeeqa S, Maqsood M, Ahmad M. Prevalence of statin induced myopathy in Lahore, Pakistan. Pak J Pharm Sci 2018;31(2(Suppl.)):617-22.
13. Iwere RB, Hewitt J. Myopathy in older people receiving statin therapy: a systematic review and meta-analysis. Br J Clin Pharmacol 2015;80(3):363-71
14. Bitzur R, Cohen H, Kamari Y, Harats D. Intolerance to statins: mechanisms and management. Diabetes Care 2013;36 Suppl 2:S325-30.
15. Tran C, Knowles SR, Liu BA, Shear NH. Gender differences in adverse drug reactions. J Clin Pharmacol 1998;38(11):1003-9.
16. Anderson GD. Gender differences in pharmacological response. Int Rev Neurobiol 2008;83:1-10.
17. Rademaker M. Do women have more adverse drug reactions? Am J Clin Dermatol 2001;2(6):349-51.
18. Manoj K, Jain N, Madhu SV. Myopathy in Patients Taking Atorvastatin: A Pilot Study. Indian J Endocrinol Metab 2017;21(4):504-9.
19. Bruckert E, Hayem G, Dejager S, Yau C, Begaud B. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients--the PRIMO study. Cardiovasc Drugs Ther 2005;19(6):403-14.
20. Parker BA, Capizzi JA, Grimaldi AS, et al. Effect of statins on skeletal muscle function. Circulation 2013;127(1):96-103.
21. Bellosta S, Paoletti R, Corsini A. Safety of statins: focus on clinical pharmacokinetics and drug interactions. Circulation 2004;109(23 Suppl 1):III50-7.
IssueVol 8, No 4 (Autumn 2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v8i4.5239
Atorvastatin; Myalgia; Risk Factors; Drug-Related Side Effects and Adverse Reactions; Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Dastan F, Salamzadeh J, Saffaei A, Nabavi Y, Abbasinazari M. Atorvastatin-Induced Myalgia in Iranian Patients: A Hospital-Based Study to Determine the Prevalence and Associated Risk Factors. J Pharm Care. 2020;8(4):176-179.