DRUG-INDUCED MYOPATHIES
Drugs (including glucocorticoids and lipid-lowering agents) and toxins (e.g., alcohol) are associated with myopathies (Table 198-2). In most cases, weakness is symmetric and involves proximal limb girdle muscles; myalgia and cramps may also occur. An elevated CK is often found. Diagnosis often depends on resolution of signs and symptoms with removal of offending agent.
DRUGS | MAJOR TOXIC REACTION |
---|---|
Lipid-lowering agents HMG-CoA reductase inhibitors Fibric acid derivatives Niacin (nicotinic acid) | Drugs belonging to all three of the major classes of lipid-lowering agents can produce a spectrum of toxicity: asymptomatic serum creatine kinase elevation, myalgias, exercise-induced pain, rhabdomyolysis, and myoglobinuria. |
Glucocorticoids | Acute, high-dose glucocorticoid treatment can cause acute quadriplegic myopathy. These high doses of steroids are often combined with nondepolarizing neuromuscular blocking agents but the weakness can occur without their use. Chronic steroid administration produces predominantly proximal weakness. |
Nondepolarizing neuromuscular blocking agents | Acute quadriplegic myopathy can occur with or without concomitant glucocorticoids. |
Zidovudine | Mitochondrial myopathy with ragged red fibers |
Drugs of abuse Alcohol Amphetamines Cocaine Heroin Phencyclidine Meperidine | All drugs in this group can lead to widespread muscle breakdown, rhabdomyolysis, and myoglobinuria. Local injections cause muscle necrosis, skin induration, and limb contractures. |
Autoimmune myopathy Statins Checkpoint inhibitors D-Penicillamine | Use of statins may cause an immune-mediated necrotizing myopathy associated with HMG-CoA reductase antibodies. Check point inhibitors can be complicated by myositis, myasthenia gravis, and immune-mediated neuropathies. Myasthenia gravis has also been reported with penicillamine. |
Amphophilic cationic drugs Amiodarone Chloroquine Hydroxychloroquine | All amphophilic drugs have the potential to produce painless, proximal weakness associated with necrosis and autophagic vacuoles in the muscle biopsy. |
Antimicrotubular drugs Colchicine | This drug produces painless, proximal weakness especially in the setting of renal failure. Muscle biopsy shows necrosis and fibers with autophagic vacuoles. |
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Kasper, Dennis L., et al., editors. "DRUG-INDUCED MYOPATHIES." Harrison's Manual of Medicine, 20th ed., McGraw Hill Inc., 2020. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623493/all/DRUG_INDUCED_MYOPATHIES.
DRUG-INDUCED MYOPATHIES. In: Kasper DLD, Fauci ASA, Hauser SLS, et al, eds. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623493/all/DRUG_INDUCED_MYOPATHIES. Accessed November 10, 2024.
DRUG-INDUCED MYOPATHIES. (2020). In Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (Eds.), Harrison's Manual of Medicine (20th ed.). McGraw Hill Inc.. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623493/all/DRUG_INDUCED_MYOPATHIES
DRUG-INDUCED MYOPATHIES [Internet]. In: Kasper DLD, Fauci ASA, Hauser SLS, Longo DLD, Jameson JLJ, Loscalzo JJ, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. [cited 2024 November 10]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623493/all/DRUG_INDUCED_MYOPATHIES.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - DRUG-INDUCED MYOPATHIES
ID - 623493
ED - Jameson,J Larry,
ED - Loscalzo,Joseph,
ED - Kasper,Dennis L,
ED - Fauci,Anthony S,
ED - Hauser,Stephen L,
ED - Longo,Dan L,
BT - Harrison's Manual of Medicine
UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623493/all/DRUG_INDUCED_MYOPATHIES
PB - McGraw Hill Inc.
ET - 20
DB - Harrison's Manual of Medicine
DP - Unbound Medicine
ER -