A 71-year-old woman is receiving a drug to lower her serum cholesterol. Over the past week, she has developed muscle pain and weakness unrelated to physical activity. On examination, she has diffuse but mild muscle tenderness. Laboratory studies show her serum creatine kinase is 2049 U/L and creatinine is 2 mg/dL. Urine dipstick analysis is positive for blood, without RBCs on urine microscopy. Which of the following drugs is most likely to produce her findings?
She has a statin-induced myopathy, with a creatine kinase level more than 10 times normal from rhabdomyolysis (myoglobin released from muscle can be detected by the urine dipstick). Statins are HMG-CoA reductase inhibitors that reduce endogenous cholesterol synthesis in the liver. Cholestyramine binds bile acids in the intestine and disrupts enterohepatic bile acid circulation to increase the conversion of cholesterol to bile acids in the liver. Clofibrate enhances uptake and oxidation of free fatty acids in muscle. Ezetimibe interferes with intestinal lipid absorption. Nicotinic acid inhibits the mobilization of peripheral free fatty acids to reduce hepatic triglyceride synthesis and secretion of VLDL.
Cholestyramine
Clofibrate
Ezetimibe
Lovastatin
Peripheral Nerve & Skeletal Muscles