Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 5-6, Pages: 387-389
https://doi.org/10.2298/SARH1306387S
Full text ( 1279 KB)
Cited by
Simvastatin-induced nocturnal leg pain disappears with pravastatin substitution
Stojaković Nataša (Univerzitet u Banjaluci, Medicinski fakultet, Katedra za farmakologiju, toksikologiju i kliničku farmakologiju, Banjaluka, Republika Srpska, Bosna i Hercegovina)
Igić Rajko (Department of Pharmacology, Toxicology, and Clinical Pharmacology, Medical School, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina + Department of Anesthesiology and Pain Management, John Stoger Hospital of Cook County, Ch)
Introduction. Statins have similar side effects that do not always occur at
the same rate among the various statins. We present a case of
simvastatin-induced muscle toxicity that disappeared when pravastatin was
substituted for the original drug. Case Outline. A 74-year-old male, a
nonsmoker, complained of severe nocturnal leg cramps. The patient also
complained that similar painful cramping occurred when he walked rapidly or
jogged. Because some components of his lipid panel exceeded the ‘desirable’
range, and as he had a history of myocardial infarction, his family physician
prescribed simvastatin (40 mg/day). The patient had taken this medication for
the past eight years. The painful nocturnal episodes started two years ago
and affected either one or the other leg. Four months ago we discontinued his
simvastatin and prescribed pravastatin (80 mg/day). At a follow-up visit six
weeks later, the patient reported that his leg pains at night and the pain
experienced after brisk walking had disappeared. Four months after the
substitution of pravastatin for simvastatin, the patient reported that his
complete lack of symptoms had continued. Conclusion. These painful muscle
cramps were probably caused by an inadequate vascular supply to the calf and
foot muscles. Perhaps a combination of advanced age and atherosclerotic
changes created a predisposition for the simvastatin-induced leg cramps.
Pravastatin differs from simvastatin in several ways. It is not metabolized
by cytochrome P450 (CYP) 3A4 oxidases, and thus is not influenced by CYP 3A4
inhibitors like simvastatin. Also, simvastatin is associated with
single-nucleotide polymorphisms located within the SLCO1B1 gene on the
chromosome 12 and established myopathy, while pravastatin lacks this
association. These differences may contribute to increased tolerance to
pravastatin in this particular case.
Keywords: statins, simvastatin, pravastatin, nocturnal leg cramps