Canadian Journal of Cardiology

Ezetimibe-associated myopathy in monotherapy and in combination with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor

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      Two cases of myopathy associated with ezetimibe are reported. In the first case, a woman on ezetimibe monotherapy presented with muscle pain and an elevated concentration of creatine kinase (CK) on two occasions, with ezetimibe 10 mg and with ezetimibe 5 mg after a washout period. The recurrence of muscle pain after washout and the CK increase both supported the hypothesis that ezetimibe alone can be linked to myalgia. In the second case, a man had been treated with atorvastatin, and ezetimibe 10 mg was added to improve his lipid profile. Two months later, the patient complained of muscle pain and a CK increase was noted. The appearance of symptoms when adding ezetimibe to atorvastatin supports a potential pharmacokinetic and/or a pharmacodynamic interaction between these two drugs. These cases suggest that ezetimibe monotherapy as well as ezetimibe associated with the use of a statin may induce myalgia. The mechanism by which ezetimibe could cause muscle pain is not known.
      Nous rapportons deux cas de myopathies associées à l’ézétimibe. Une femme se présente avec des douleurs musculaires et une élévation de la créatine kinase (CK) sous ézétimibe en monothérapie et ce en deux occasions : 1) avec ézétimibe 10 mg et, 2) avec ézétimibe 5 mg après une période sans traitement. La réapparition des douleurs musculaires après la période sans traitement et l’augmentation des CK appuient l’hypothèse selon laquelle l’ézétimibe seul pourrait causer des myalgies. Afin d’améliorer le profil lipidique d’un homme traité avec de l’atorvastatine, un traitement d’ézétimibe 10 mg fut ajouté. Deux mois plus tard, le sujet présente des douleurs musculaires associées à une augmentation des CK. L’apparition des symptômes à l’ajout de l’ézétimibe au traitement à l’aide d’atorvastatine soutient une interaction pharmacocinétique ou pharmacodynamique potentielle entre ces deux médicaments. Nos résultats indiquent que l’ézétimibe en monothérapie autant qu’en association avec des statines pourrait induire de la myalgie. Le mécanisme par lequel l’ézétimibe pourrait causer des douleurs musculaires n’est pas connu.

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