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What Causes Muscle Pain, Fatigue And Body Itching After Increasing Pravastatin Dosage?
Question: 9/01/17 -- 76 yr old female: Statins for high chol & triglycerides APPEAR to be having impact on muscle/joint pain. I had been on Lipitor for yrs (well tolerated) - chol ratio was 4 or under. Because of fatigue & muscle pain issues (2014-2017), discontinued Lipitor for 3 mos (Spring 2017) to monitor symptoms. Additional blood testings then indicated increased Chol (365) & Triglycerides (308) - ratio went from 4.3 to 7.0 while taking no med. Card switched me to Pravastatin (40 mg @ bed). Additional blood draw showed some improvement Chol (309) & Tri (325) - ratio went from 7.0 to 5.0. Card increased Prav to 80 mg about 3 wks ago. I will be having blood re-check in about 1 mo for comparison. Complaints: joint/muscle pain, fatigue, itching. I also have osteo-arthritis, degenerative disc disease (cervical), tinnitus. During the past 2 yrs I've been on several different Rx for nerve pain (occipital neuralgia, cervical radiculopathy involving shoulders/arms): Flexeril, Baclofen, Trazadone, Remeron, Neurontin - all resulted in minimal relief & undesirable side effects & have been disc. I am now taking Cymbalta as muscle relaxer - pain relief -- with little success except helpful as a sleep aid. Arthritis dr is now suggesting switching to TIZANIDINE - 2 mg. I have not yet rec'd from pharm.
Q: PRESUMING (?) that muscle/joint discomfort is exacerbated by statins and I stop them altogether (as before) and Chol/Tri levels spike, what other "options" might be on the table for me? I also take CARDIZEM, LOSARTAN, METOPROLOL, LASIX, POTASSIUM CL, OMEPRAZOLE & Advil or Aleve. BP & weight are within normal limits. Pain is hindrance re: exercise regimen - which I know I need & would be beneficial for lowering chol/trig. Rec'd heart stent 2011 & card re-hab - no problem since. Also had 2-3 mos of PT program in 2015-16 for occipital neuralgia & epidural injections (minimal improvement). THANK YOU. XXXX
Q: PRESUMING (?) that muscle/joint discomfort is exacerbated by statins and I stop them altogether (as before) and Chol/Tri levels spike, what other "options" might be on the table for me? I also take CARDIZEM, LOSARTAN, METOPROLOL, LASIX, POTASSIUM CL, OMEPRAZOLE & Advil or Aleve. BP & weight are within normal limits. Pain is hindrance re: exercise regimen - which I know I need & would be beneficial for lowering chol/trig. Rec'd heart stent 2011 & card re-hab - no problem since. Also had 2-3 mos of PT program in 2015-16 for occipital neuralgia & epidural injections (minimal improvement). THANK YOU. XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I passed carefully through your question and I agree with you that your symptoms may be triggered by pravastatin, especially considering the fact that increasing the dose lately worsened your clinical situation.
Coming to this point, I would first recommend trying to reduce the dose again to 40mg.
I would also recommend checking your muscular enzymes (CPK, LDH) and liver enzymes (AST, ALT) in order to closely monitor this adverse effect of statins (these enzymes are usually raised as an adverse effect of statins).
Considering the fact that you are taking Potassium chloride, I would recommend checking also your potassium plasma levels.
If reducing the dose of pravastatin, does not improve your clinical situation, I would recommend trying to stop it for a month and begin again with low doses.
Another treatment option would be Zetia (ezetimibe), but you should know that its adverse effects are similar to statins. So, we can not be sure that you will experience the same adverse effects even with this drug.
I would also strongly encourage you to follow a healthy lifestyle (being active and avoid fat and hypercaloric food).
Food reach in omega 3 fatty acids would help too (fish, fish oil, walnuts, olive oil, etc.).
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I passed carefully through your question and I agree with you that your symptoms may be triggered by pravastatin, especially considering the fact that increasing the dose lately worsened your clinical situation.
Coming to this point, I would first recommend trying to reduce the dose again to 40mg.
I would also recommend checking your muscular enzymes (CPK, LDH) and liver enzymes (AST, ALT) in order to closely monitor this adverse effect of statins (these enzymes are usually raised as an adverse effect of statins).
Considering the fact that you are taking Potassium chloride, I would recommend checking also your potassium plasma levels.
If reducing the dose of pravastatin, does not improve your clinical situation, I would recommend trying to stop it for a month and begin again with low doses.
Another treatment option would be Zetia (ezetimibe), but you should know that its adverse effects are similar to statins. So, we can not be sure that you will experience the same adverse effects even with this drug.
I would also strongly encourage you to follow a healthy lifestyle (being active and avoid fat and hypercaloric food).
Food reach in omega 3 fatty acids would help too (fish, fish oil, walnuts, olive oil, etc.).
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
9/01/17 Dr. Sharka: Thank you for your review & prompt reply. I will cut back Pravastatin to 40 mg & consult with card later this month. I already have an order from him for repeat LIPID PANEL, AST, ALT, CK/CPK at end of Sept. I will also discuss with him re: including Potassium levels. I note that my Potassium has been in the range of 4.2 - 4.8 during the past 2 1/2 yrs.
Additionally, my former Card (now retired) had prescribed Zetia 10 mg in addition to Lipitor 40 mg because of Lipid Panel results. I did this for about 2 yrs. Because of muscle discomfort AND GI upset, I disc Zetia and remained on Lipitor until PCP suggested disc for 6 wks to monitor any change in muscle/joint issue & evaluate Chol/Trig levels. Did not notice significant benefit while off Lipitor, so re-started. New Card then prescribed change from Lipitor to Pravastatin 40 mg, which has now become 80 mg.
Having these "issues" with Lipitor, Zetia & Prav, would seem to leave me little left in the Rx field to choose from. - that I know of (?) I will heed your advice as to more fish, olive oil, & add plain walnuts to my diet. Hopefully, I will notice some relief from the pain issues (arthritic & disc) and be able to focus more on exercise routine. Again, thanks for your review & information. XXXX
Additionally, my former Card (now retired) had prescribed Zetia 10 mg in addition to Lipitor 40 mg because of Lipid Panel results. I did this for about 2 yrs. Because of muscle discomfort AND GI upset, I disc Zetia and remained on Lipitor until PCP suggested disc for 6 wks to monitor any change in muscle/joint issue & evaluate Chol/Trig levels. Did not notice significant benefit while off Lipitor, so re-started. New Card then prescribed change from Lipitor to Pravastatin 40 mg, which has now become 80 mg.
Having these "issues" with Lipitor, Zetia & Prav, would seem to leave me little left in the Rx field to choose from. - that I know of (?) I will heed your advice as to more fish, olive oil, & add plain walnuts to my diet. Hopefully, I will notice some relief from the pain issues (arthritic & disc) and be able to focus more on exercise routine. Again, thanks for your review & information. XXXX
Brief Answer:
You are welcome!
Detailed Answer:
Hello again!
Thank you for the additional information.
Coming to this point, there is not too much to be done regarding your medications options, as it seems that you do not tolerate well statins or Zetia.
So, you can try to make the dose modifications of statins (use lower doses), in combination with a healthy diet (low saturated fat, low sugar, a lot of fibbers and a lot of food rich in omega 3 fatty acids like above mentioned).
Wishing all the best,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again!
Thank you for the additional information.
Coming to this point, there is not too much to be done regarding your medications options, as it seems that you do not tolerate well statins or Zetia.
So, you can try to make the dose modifications of statins (use lower doses), in combination with a healthy diet (low saturated fat, low sugar, a lot of fibbers and a lot of food rich in omega 3 fatty acids like above mentioned).
Wishing all the best,
Dr. Iliri
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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