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Myopathien unter der Therapie mit Lipidsenkern

Myopathies under therapy with lipid-lowering agents

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Zusammenfassung

Zu den wichtigsten Nebenwirkungen der cholesterinsenkenden Therapie mit Fibraten und den die 3-Hydroxy-3-methyl-glutaryl-Coenzym-A- (HMG-CoA-)Reduktase hemmenden Statinen gehört die Auslösung einer Myopathie, die von Myalgien ohne Creatinkinase- (CK-)Erhöhung über klinisch asymptomatische CK-Anstiege bis hin zu lebensbedrohlichen Rhabdomyolysen mit Nierenversagen reichen kann. Mit Ausnahme des 2001 vom Markt genommenen Cerivastatins sind bedrohliche Rhabdomyolysen unter Therapie mit Statinen mit einer geschätzten Inzidenz von unter 0,2/1 Mio. Verschreibungen sehr seltene Nebenwirkungen. Muskelschmerzen und Muskelkrämpfe ohne CK-Anstiege werden jedoch von bis zu 5% der behandelten Patienten geklagt, sind aber in den Therapiestudien in gleicher Häufigkeit auch in den Plazebogruppen aufgetreten und können so nicht unbedingt der Medikation zugerechnet werden. Wegen des sehr verbreiteten Einsatzes der Statine und Fibrate stellen aber die Differenzialdiagnose und das Management einer durch Lipidsenker ausgelösten Myopathie in den neuromuskulären Spezialambulanzen eine zunehmend häufigere Frage dar.

Summary

Myopathies ranging from myalgia to clinically asymptomatic creatine kinase (CK) elevation and to life-threatening rhabdomyolysis belong to the most important complications of lipid-lowering therapies with fibrates and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, i.e., statins. Rhabdomyolysis is a rare side effect of statin therapy with an estimated incidence of 0.2/1 million prescriptions. Myalgia and muscle cramps were reported by up to 5% of patients, but they were observed with the same percentage in controls receiving placebo. Due to increasing numbers of patients under lipid-lowering therapy, however, more and more patients present in neuromuscular units with the differential diagnosis of a fibrate- or statin-induced myopathy.

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Authors and Affiliations

  1. Neurologische Klinik der Heinrich-Heine-Universität, Düsseldorf

    H. Köller, O. Neuhaus, M. Schroeter & H.-P. Hartung

  2. Neurologische Klinik der Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Postfach 101007, 40001, Düsseldorf, Deutschland

    H. Köller

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  1. H. Köller
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  2. O. Neuhaus
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  4. H.-P. Hartung
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Correspondence to H. Köller.

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Köller, H., Neuhaus, O., Schroeter, M. et al. Myopathien unter der Therapie mit Lipidsenkern . Nervenarzt 76, 212–218 (2005). https://doi.org/10.1007/s00115-004-1837-x

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