Mechanisms and assessment of statin‐related muscular adverse effects. (September 2014)

• Record Type: Journal Article
• Authors: Moßhammer, Dirk; Schaeffeler, Elke; Schwab, Matthias; Mörike, Klaus
• Is Part Of: British journal of clinical pharmacology. Volume 78:Number 3(2014:Sep.)
• Page Start: 454
• Page End: 466
• Publication Date: 2014-09
• Subjects: Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.12360
• Languages: English
• ISSNs: 0306-5251

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>Statin‐associated muscular adverse effects cover a wide range of symptoms, including asymptomatic increase of creatine kinase serum activity and life‐threatening rhabdomyolysis. Different underlying pathomechanisms have been proposed. However, a unifying concept of the pathogenesis of statin‐related muscular adverse effects has not emerged so far. In this review, we attempt to categorize these mechanisms along three levels. Firstly, among pharmacokinetic factors, it has been shown for some statins that inhibition of cytochrome P450‐mediated hepatic biotransformation and hepatic uptake by transporter proteins contribute to an increase of systemic statin concentrations. Secondly, at the myocyte membrane level, cell membrane uptake transporters affect intracellular statin concentrations. Thirdly, at the intracellular level, inhibition of the 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase results in decreased intracellular concentrations of downstream metabolites (e.g. selenoproteins, ubiquinone, cholesterol) and alteration of gene expression (e.g. ryanodine receptor 3, glycine amidinotransferase). We also review current recommendations for prescribers.</p> </abstract>