Statins Wrongly Accused of Causing Myalgia – Guilty By Association Janelle F. Ruisinger, PharmD, 1,2,3 James M. Backes, PharmD, 1,2,3 Patrick M. Moriarty, MD 2,3

1University of Kansas School of Pharmacy, Kansas City, KS 2School of Medicine, Internal Medicine, University of Kansas Medical Center, Kansas City, KS

3Atherosclerosis and LDL-Apheresis Center, Kansas City, KS

• Statins are generally well tolerated, but some patients discontinue the

agents due to skeletal muscle and/or joint complaints

•Other potential causes of arthralgia and myalgia should be

investigated including:

• Other medications

• Disease states

• Vitamin deficiency

• Food additives: preservatives, artificial sweeteners

•Musculoskeletal effects have been reported with chronic ingestion of

artificial sweeteners, particularly aspartame

• To the best of our knowledge, myalgia and arthralgia with sucralose

have not been previously reported

BACKGROUND

• Abrupt discontinuation of coffee and sucralose resulted in complete muscle and joint pain

resolution within 36 hours

• Patient permanently discontinued sucralose consumption

• Atorvastatin 80 mg daily was started and tolerated for 9 months without complaints

• Later switched to rosuvastatin 40 mg daily and continues to tolerate without adverse

effects

• Currently, the patient consumes several cups of decaffeinated coffee daily sweetened

with steviol glycosides (Stevia®) or erythritol/rebiana (Truvia®) without issue

MANAGEMENT

1. Ciappuccini R, Ansemant T, Maillefert JF, et al. Aspartame-induced

fibromyalgia, an unusual but curable cause of chronic pain. Clin Exp

Rheumatol. 2010 Nov-Dec;28(6 Suppl 63):S131-3. Epub 2010 Dec 22e

2. Smith JD, Terpening CM, Schmidt SO, et al. Relief of fibromyalgia symptoms

following discontinuation of dietary excitotoxins. Ann Pharmacother. 2001

Jun;35(6):702-6

Janelle Ruisinger, PharmD

jruisinger@kumc.edu

Office phone: 913.588.2608

CONTACT INFORMATION

• Literature search performed in PubMed

• Relevant findings of myalgia associated with food additive ingestion:

1. Case reports of two patients whose fibromyalgia symptoms resolved after

discontinuing aspartame consumption.1

2. A report of four female patients diagnosed with fibromyalgia. All four

patients experienced complete or near complete resolution of fibromyalgia

pain upon discontinuation of monosodium glutamate (MSG) or MSG plus

aspartame. All the patients experienced recurrence of fibromyalgia pain

when MSG was reinitiated.2

LITERATURE REVIEW

• Practitioners with patients suffering from apparent statin-associated

myalgia and arthralgia should inquire about ingestion of food

additives including:

• Aspartame

• Sucralose

• MSG

• Discontinued ingestion of these agents may provide relieve to muscle

and/or joint symptoms

DISCUSSION

•Our patient did not experience statin-associated myalgia and

arthralgia

•Muscle and joint pain was likely a result of daily sucralose ingestion

• Eliminating sucralose from his diet enabled the patient to tolerate a

high intensity statin daily

CONCLUSIONS

REFERENCES

• 65 year old Caucasion male with pure hypercholesterolemia and

coronary heart disease (angina and stent placement) was referred to

a lipid specialty clinic

• Positive history of myalgia with daily statin therapy despite normal

serum creatine kinase levels

•Over the next 4 years, the patient was prescribed intermittent dosing

with rosuvastatin and pitavastatin

• Rosuvastatin 10 mg weekly caused intolerable myalgia and

arthralgia

• Pitavastatin 2 mg twice weekly also caused myalgia and

arthralgia but symptoms were tolerable

• During this time, the patient noticed an association between severity

of myalgia and arthralgia and his coffee and sucralose (Splenda®)

intake

• In August 2014 patient experienced severe muscle and joint pain

while at his peak intake of sucralose. At this time he was consuming:

• Pitavastatin 2 mg twice weekly

• 6-7 cups of decaffeinated coffee daily

• 12-14 one gram packets of sucralose daily

• To highlight apparent skeletal muscle and joint effects of sucralose in

a patient with perceived statin-associated myalgia and arthralgia

PURPOSE

CASE REPORT

Authors of this presentation have nothing to disclose concerning possible financial

or personal relationships with commercial entities that may have a direct or

indirect interest in the subject matter of this presentation.

PANEL DISCLOSURE