Myopathies - drug-induced
Description
- *The commonest cause of myopathy in hospital practice* - and the only one where the cure is a prescription change
- Five mechanisms, and they behave differently:
| Mechanism | Example | CK | Course after stopping |
|---|---|---|---|
| Atrophic/metabolic | Glucocorticoids | NORMAL | Reverses over weeks-months |
| Necrotising (direct toxic) | Statins, fibrates, alcohol | inc | Reverses |
| IMMUNE-mediated necrotising | Statin -> anti-HMGCR IMNM | >10x ULN | *PERSISTS or WORSENS - needs immunosuppression* |
| Inflammatory/autoimmune | Checkpoint inhibitors, D-penicillamine, interferon | inc | Needs immunosuppression |
| Amphiphilic / autophagic | Hydroxychloroquine, amiodarone, colchicine | inc or normal | Slow (months) |
| Mitochondrial | Zidovudine, statins (coenzyme Q10 depletion) | inc | Slow |
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