Drugs That Cause Muscle Pain And Weakness

Statins and Muscle Pain

Statins are widely prescribed to lower cholesterol and reduce the risk of cardiovascular diseases. However, they are known to cause muscle-related side effects in some patients. Mild muscle symptoms without weakness or creatine kinase (CK) elevations occur in 5-10% of users. In rare cases, statins can lead to severe conditions like rhabdomyolysis, characterized by significant muscle damage and elevated CK levels. Autoimmune myopathy associated with statins, marked by anti-HMG-CoA reductase autoantibodies, can cause persistent muscle weakness and requires immunosuppressive treatment .

Antiretroviral Drugs and Muscle Weakness

Antiretroviral drugs such as efavirenz (EFV), atazanavir (ATV), and ritonavir (RTV) used in HIV treatment can disrupt calcium homeostasis in skeletal muscles, leading to muscle fatigue, pain, and weakness. These drugs affect the sarcoplasmic reticulum's calcium cycling, which is crucial for muscle function, potentially contributing to muscle co-morbidities in people living with HIV.

Glucocorticoids and Muscle Atrophy

Glucocorticoids are another class of drugs that can induce myopathy, particularly with prolonged use. This condition, known as glucocorticoid-induced myopathy, is characterized by muscle weakness, fatigue, and atrophy without pain. The myopathy is most commonly associated with fluorinated glucocorticoids like dexamethasone. The primary mechanism involves decreased protein synthesis and increased protein catabolism in muscles. Treatment typically involves reducing or discontinuing the glucocorticoid and switching to non-fluorinated alternatives .

Anti-Dopaminergic Medications and Respiratory Muscle Weakness

Anti-dopaminergic medications, such as risperidone and ziprasidone, can cause severe muscle toxicity, including respiratory muscle weakness. This can lead to significant clinical complications, such as the need for mechanical ventilation. Discontinuation of the offending drug usually results in clinical improvement.

Other Myotoxic Medications

Several other medications are known to cause muscle pain and weakness, including:

Colchicine: Used for gout treatment, can cause myopathy that resolves upon discontinuation .
Hydroxychloroquine: An antimalarial drug that can induce muscle weakness and pain .
High-dose prednisone: A glucocorticoid that can lead to muscle atrophy and weakness .
Propoxyphene: An analgesic that, when abused, can cause severe myopathic symptoms.

Conclusion

Many commonly prescribed drugs have the potential to cause muscle pain and weakness. Statins, antiretroviral drugs, glucocorticoids, anti-dopaminergic medications, and others can lead to varying degrees of muscle-related side effects. Recognizing these drug-induced myopathies early and discontinuing the offending medication can often lead to resolution of symptoms and prevent further complications.

Drugs that cause muscle pain and weakness

Summary

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