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Lovastatin/gemfibrozil myopathy: a clinical, histochemical, and ultrastructural study
A Chucrallah1, U De Girolami, R Freeman
1Department of Pathology, New England Deaconess Hospital, Boston, Mass.
European Neurology
|January 1, 1992
Summary
Combining lovastatin and gemfibrozil for hypercholesterolemia can cause severe muscle weakness. Discontinuing these drugs led to rapid improvement in a patient with necrotizing myopathy.
Area of Science:
- Pharmacology
- Neurology
- Pathology
Background:
- Lovastatin is frequently prescribed to lower serum cholesterol.
- Muscle weakness is a serious side effect of long-term lovastatin use, often exacerbated by gemfibrozil or cyclosporine.
Observation:
- A 57-year-old woman on lovastatin and gemfibrozil presented with progressive leg and neck muscle weakness.
- Neurological examination indicated severe proximal muscle weakness, tenderness, and areflexia.
Findings:
- Muscle biopsy revealed necrotizing myopathy with mononuclear cell infiltration and myophagocytosis.
- Electron microscopy showed subsarcolemmal autophagic lysosome accumulation in muscle fibers.
Implications:
- Concurrent use of lovastatin and gemfibrozil may precipitate severe myopathy.
- Discontinuation of these medications can lead to significant clinical improvement in affected patients.