1
|
Steinmeyer J, Flechtenmacher J. Drug-induced Myopathies. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:175-181. [PMID: 34320661 DOI: 10.1055/a-1488-6912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Differential diagnosis of muscle pain and weakness is extensive, including neurological, vertebral, arthrogenic, vascular, traumatic, immunological, endocrine, genetic and infectious aetiologies, as well as medication or toxin-related causes. Muscles are highly sensitive to a large number of drugs, especially with high doses. Although many drug classes can cause toxic myopathy, a significant number of cases are caused by lipid-lowering drugs, long-term use of corticosteroids, and, most often, alcohol misuse. Some drug interactions, e.g. those that are metabolised via the enzyme CYP3A4, can increase the serum levels of the drugs and drug-induced toxicity. A careful history of patient's drug and alcohol consumption is therefore vital. Clinical symptoms depend on the drug, dosage and patient's sensitivity. They can vary from asymptomatic increase in serum levels of creatine kinase, mild myalgia and cramps to muscle weakness, rhabdomyolysis, kidney failure and even death. The pathogenesis is often only partially known and multifactorial. Toxic myopathy is often reversible once the drug is discontinued, alternative drug therapy is started or a different dosage regimen is chosen. Complications such as acute kidney failure must be avoided, and analgesic therapy may be indicated.
Collapse
Affiliation(s)
- Jürgen Steinmeyer
- Laboratory for Experimental Orthopaedics, Dept. of Orthopaedics, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Flechtenmacher
- Professional Association for Orthopaedic and Trauma Surgery (BVOU), Berlin, Germany.,Ortho-Zentrum, Orthopaedic Group Practice at Ludwigsplatz, Karlsruhe, Germany
| |
Collapse
|
2
|
Kim EJ, Wierzbicki AS. Investigating raised creatine kinase. BMJ 2021; 373:n1486. [PMID: 34162592 DOI: 10.1136/bmj.n1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Eun Ji Kim
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, London, UK
| | - Anthony S Wierzbicki
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, London, UK
| |
Collapse
|
3
|
Voriconazole- induced severe hypokalemic rhabdomyolysis: A case report. Int J Pediatr Adolesc Med 2021; 9:66-68. [PMID: 35573070 PMCID: PMC9072235 DOI: 10.1016/j.ijpam.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022]
Abstract
We report a child who presented with lower limb weakness and inability to walk, laboratory confirmed severe hypokalemia with typical electrocardiogram changes, and evidence of rhabdomyolysis while on voriconazole treatment for Pseudallescheria boydii soft tissue infection. Although voriconazole is a well-tolerated antifungal agent, hypokalemia is a well-known, yet uncommon side effect associated with its use. Furthermore, hypokalemic-rhabdomyolysis has not been reported with voriconazole use alone. Maintaining the clinical suspicion about the potential association between voriconazole and hypokalemic-rhabdomyolysis can lead to prompt recognition and intervention.
Collapse
|
4
|
Boon JT, Maxwell CA. Policy Opportunities to Support Family Caregivers Managing Pain in People with Dementia. Pain Manag Nurs 2020; 22:8-10. [PMID: 32690469 DOI: 10.1016/j.pmn.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey T Boon
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | |
Collapse
|
5
|
Olmos-Martínez JM, Molina H, Salas C, Olmos JM, Hernández JL. Acute Colchicine-induced Neuromyopathy in a Patient Treated with Atorvastatin and Clarithromycin. Eur J Case Rep Intern Med 2019; 6:001066. [PMID: 30931282 PMCID: PMC6438112 DOI: 10.12890/2019_001066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022] Open
Abstract
Neuromyopathy is a rare side effect of chronic colchicine therapy, especially without renal impairment. Drugs interacting with colchicine metabolism through CYP3A4 can accelerate accumulation and toxicity. We describe a case of an interaction between atorvastatin, clarithromycin and colchicine resulting in acute neuromyopathy.
Collapse
Affiliation(s)
- José M Olmos-Martínez
- Gastroenterology and Hepatology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Helena Molina
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Cristina Salas
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - José M Olmos
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - José L Hernández
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| |
Collapse
|
6
|
Lahouti AH, Christopher-Stine L. Inflammatory Muscle Diseases. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Domingo-Horne RM, Salajegheh MK. An Approach to Myopathy for the Primary Care Clinician. Am J Med 2018; 131:237-243. [PMID: 29074094 DOI: 10.1016/j.amjmed.2017.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/19/2022]
Abstract
Patients with muscle weakness are frequently encountered in the primary care clinic; however, the identification of an underlying disorder of muscle can pose a significant challenge. The aim of this review article is to provide a clinical and diagnostic framework to aid the primary care clinician in the detection and evaluation of suspected myopathies.
Collapse
Affiliation(s)
- Rose M Domingo-Horne
- VA Boston Healthcare System, Neurology Service/Division of Neuromuscular Medicine, Harvard Medical School, Boston, Mass
| | - Mohammad Kian Salajegheh
- VA Boston Healthcare System, Neurology Service/Division of Neuromuscular Medicine, Harvard Medical School, Boston, Mass.
| |
Collapse
|
8
|
Jiang W, Wang X, Zhou S. Rhabdomyolysis induced by antiepileptic drugs: characteristics, treatment and prognosis. Expert Opin Drug Saf 2016; 15:357-65. [DOI: 10.1517/14740338.2016.1139572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
9
|
Abstract
PURPOSE OF REVIEW Clinically identified myopathies are frequently a consequence of medication toxicities. However, recognizing drug-induced myopathies is sometimes difficult. Developing a greater understanding of the underlying mechanisms of drug-induced muscle toxicity will promote enhanced awareness and recognition, and improved management of these syndromes. RECENT FINDINGS The adverse impact of certain drugs on muscle metabolism, muscle cell atrophy, and myocyte apoptosis is increasingly clear. Glucocorticoids impair glucose handling and directly promote protein catabolism. Statins impair mitochondrial function and alter intracellular signaling proteins, which can lead to myocyte apoptosis. Alternatively, statins can induce an autoimmune necrotizing myositis. Several medications impair autophagy, thus limiting access to the needed glycogen stores. SUMMARY This review provides an overview of the main underlying mechanisms of drug-induced myopathies. These myopathies will most often be related to a drug's ability to alter metabolism and protein balance, induce necrosis, or impair autophagy.
Collapse
|
10
|
Sanchis-Gomar F, Pareja-Galeano H, Perez-Quilis C, Santos-Lozano A, Fiuza-Luces C, Garatachea N, Lippi G, Lucia A. Effects of allopurinol on exercise-induced muscle damage: new therapeutic approaches? Cell Stress Chaperones 2015; 20:3-13. [PMID: 25181966 PMCID: PMC4255256 DOI: 10.1007/s12192-014-0543-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 02/07/2023] Open
Abstract
Intensive muscular activity can trigger oxidative stress, and free radicals may hence be generated by working skeletal muscle. The role of the enzyme xanthine oxidase as a generating source of free radicals is well documented and therefore is involved in the skeletal muscle damage as well as in the potential transient cardiovascular damage induced by high-intensity physical exercise. Allopurinol is a purine hypoxanthine-based structural analog and a well-known inhibitor of xanthine oxidase. The administration of the xanthine oxidase inhibitor allopurinol may hence be regarded as promising, safe, and an economic strategy to decrease transient skeletal muscle damage (as well as heart damage, when occurring) in top-level athletes when administered before a competition or a particularly high-intensity training session. Although continuous administration of allopurinol in high-level athletes is not recommended due to its possible role in hampering training-induced adaptations, the drug might be useful in non-athletes. Exertional rhabdomyolysis is the most common form of rhabdomyolysis and affects individuals participating in a type of intense exercise to which they are not accustomed. This condition can cause exercise-related myoglobinuria, thus increasing the risk of acute renal failure and is also associated with sickle cell trait. In this manuscript, we have reviewed the recent evidence about the effects of allopurinol on exercise-induced muscle damage. More research is needed to determine whether allopurinol may be useful for preventing not only exertional rhabdomyolysis and acute renal damage but also skeletal muscle wasting in critical illness as well as in immobilized, bedridden, sarcopenic or cachectic patients.
Collapse
Affiliation(s)
- F Sanchis-Gomar
- Department of Physiology, University of Valencia, Av. Blasco Ibañez, 15, Valencia, 46010, Spain,
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Pain can have negative effects leading to prolonged hospital stays. Determining the presence of uncontrolled and untreated pain in patients with cognitive impairments such as delirium, dementia, and delirium superimposed on dementia (DSD) is challenging. One tool commonly suggested for use in assessment of pain in older adults with cognitive impairment is the Pain Assessment In Advanced Dementia (PAINAD) scale. Proper use of the PAINAD scale as part of a comprehensive pain management plan can help reduce the likelihood of a patient experiencing unrecognized and untreated pain. Using an individual example, this article illustrates best practices in pain assessment and management for a woman experiencing DSD during an acute hospitalization.
Collapse
|
12
|
Colchicine-induced myoneuropathy mimicking polyradiculoneuropathy. J Clin Neurosci 2014; 21:331-2. [DOI: 10.1016/j.jocn.2013.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 01/10/2023]
|
13
|
|
14
|
Ragunathan-Thangarajah N, Le Beller C, Boutouyrie P, Bassez G, Gherardi RK, Laurent S, Authier FJ. Distinctive clinical features in arthro-myalgic patients with and without aluminum hydroxyde-induced macrophagic myofasciitis: an exploratory study. J Inorg Biochem 2013; 128:262-6. [PMID: 23921285 DOI: 10.1016/j.jinorgbio.2013.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/11/2013] [Accepted: 07/13/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED Macrophagic myofasciitis (MMF) is a specific histological lesion assessing the persistence of vaccine-derived aluminum oxyhydroxide in muscle tissue, at a site of previous immunization. Long-lasting MMF is usually detected in patients with arthromyalgias, chronic fatigue, and stereotyped cognitive dysfunction. MMF diagnosis requires muscle biopsy, an invasive procedure not suitable for the routine investigation of all patients with musculoskeletal pain. To help decision making in routine practice, we designed a retrospective analysis of 130 consecutive arthro-myalgic patients, previously immunized with aluminum-containing vaccines, in whom deltoid muscle biopsy was performed for diagnostic purposes. According to biopsy results, the patients were ascribed to either the MMF or the non-MMF group. MMF was diagnosed in 32.3% of the patients. MMF and non-MMF groups were similar according to both the injected vaccines and the delay between vaccination and biopsy. MMF patients had less frequent fibromyalgia than non-MMF patients (≥11 fibromyalgic tender points in 16.6 vs 55.5%, p < 0.04), and more often abnormal evoked potentials suggestive of CNS demyelination (38.5 vs 5.7%, p < 0.01). Predictive bioclinical scores based on simple variables such as the number of fibromyalgic tender points, arthralgias, and spinal pain, had sensitivity ranging from 50 to 88.1% and specificity from 36.4 to 76.1%. IN CONCLUSION (i) most aluminum-containing vaccine receivers do not have long-lasting MMF in their muscle, but the prevalence of MMF among patients with arthromyalgia following immunization is substantial; (ii) patients with MMF have more CNS dysfunction and less fibromyalgic tender points than non-MMF patients; (iii) predictive scores may help to identify patients at high vs low risk of MMF.
Collapse
|
15
|
Inflammatory muscle diseases. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|