Also in this case, the objective examination and the clinical history of the patient suggested the iatrogenic nature of the event. Less common. chest pain, discomfort, tightness, or heaviness. INFREQUENT side effects A Skin Rash Constipation Dizziness Joint Pain A 71 years old man in whom the cough appeared four days after he began the treatment with atorvastatin (10 mg/day) for hypercholesterolemia. In all cases the drug withdrawal determined symptomatology remission and in one case of rechallange the cough reappeared leading to the definitive interruption of the pharmacological treatment. Posted By Anonymous in askapatient.com on September 16, 2014 @ 12:00 am “ Side Effects: Dry throat in morning, occasional dry cough. Here there are the three cases in brief. We worry about cataracts, elevated blood sugar and nerve pain. Besides, increased inducible nitric oxide synthase (iNOS) expression, associated to stabilisation and potentiation of statin-mediated COX-2 activity, promotes significant cardioprotective effects.8 Recent results indicates that NO produced by NOS is an important stimulator in the normal cough reflex circuit, determining increased sensitivity of this reflex. CDI NS, Am J Physiol Heart Circ Physiol 2006;290:1960-8. increased thirst. Awareness about this correlation can be useful both to the physician – for providing a correct differential diagnosis and rationally establishing the possible iatrogenic nature of the cough – and the patient, who - knowing this possible adverse effect - could report its onset to the physician avoiding useless ulterior prescriptions. Difficulty in moving 2. joint pain or swelling 3. muscle pain, cramps, spasms, or stiffness Less common 1. Case 3. Besides, the involvement of different molecules of statins does not exclude a possible class effect. Three cases of cough in patients treated with atorvastatin. Druginformer Identified Side Effects: Cough, Dry throat. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.. The statin was immediately withdrawn, with consequent definitive remission of the cough. Exceptional cases of interstitial pulmonary disease have been reported for some statins, especially in long-term therapies; nevertheless, cough without pulmonary involvement is not yet included in the data-sheet for statins. A 70 years old woman, with hypercholesterolemia, treated with 40 mg/day of atorvastatin; two days after the beginning of the therapy she manifested dry cough. The highest number of reports for iatrogenic cough is associated to rosuvastatin (425), followed by atorvastatin (344) and by simvastatin (144), probably caused by higher prescription rate for these drugs; lovastatin (9 cases) and cerivastatin (2 cases) have been associated to the lowest number of cases. In all these reports the statin was considered the only suspect drug (Table 1). Call your doctor at once if you have: unexplained muscle pain, tenderness, or weakness; Prostanoids like PGD2, PGE2, PGF2alpha and PGI2 mediate a wide range of physiological effects by means of five receptor classes named: DP, EP, FP, IP and TP. Nausea 4. Persistent cough continued for 7 days during the therapy and disappeared only when the statin was withdrawn. In particular, statins stabilise messenger RNA in endothelial nitric oxide synthase (eNOS) leading to increased enzyme expression and NO production.6,7 The patient was then successively treated with fibrates, without presenting similar conditions anymore. It is a known side effect of Crestor. Blurred vision 2. chest pain or discomfort 3. chest tightness or he… Even though the data collected by the different databases are not homogeneous - because they reflect prescribing and reporting approaches characteristic and different for every country - the elevate number of reports we found, despite possibly overestimated, indicates a plausible relation with the statin treatment. Analysis of the reports relative to Lombardy Region collected by the AIFA database. flushed, dry skin. Our analysis considered as potential confounding factors pulmonary pathologies and concomitant drugs known for causing cough as possibly implicated in the onset of the adverse reaction. The patient was also in therapy with losartan and hydrochlorothiazide, notoriously associated to possible cough onset. One month later, atorvastatin was administered again with consequent reappearance of the cough; the therapy interruption led to complete remission of the drug adverse reaction also in this case. The table highlights the cases of iatrogenic cough relative to the administration of atorvastatin, simvastatin, rosuvastatin, fluvastatin, cerivastatin, mevastatin and pitavastatin. Muscle Pain If experienced, these tend to have a Less Severe expression 1. Table 1. Case 2. A second hypothesised mechanism, probably involved in the potentiation of the prostaglandin-mediated action, is correlated to the effect caused by these drugs on the transmission way of nitric oxide (NO). I was … fast, irregular, pounding, or racing heartbeat or pulse. The activation of this way mediates protective effects against vascular damages; statins’ beneficial role in atherosclerotic vascular diseases is in fact well known. A 70 years old woman, with hypercholesterolemia, treated with 40 mg/day of atorvastatin; two days after the beginning of the therapy she manifested dry cough. The highest number of reports for iatrogenic cough is associated to rosuvastatin (425), followed by atorvastatin (344) and by simvastatin (144), probably caused by higher prescription rate for these drugs; lovastatin (9 cases) and cerivastatin (2 cases) have been associated to the lowest number of cases. Head Pain 3. Common side effects may include: headache; weakness; muscle aches; or nausea, stomach pain. Check with your doctor immediatelyif any of the following side effects occur while taking rosuvastatin: More common 1. We found five reports, including the three cases previously discussed, all correlating cough and statins. The most likely mechanism might be linked to the capability of increasing prostaglandins and nitric oxide production, which in turn induce an increase of cough reflex sensitivity. For mevastatin and pivastatin, on the other side, we did not find similar reports. dry mouth. In particular, inhaled PGE2 can induce cough as a result of an important increase of cough reflex sensitivity itself, by binding to specific receptor molecules.4,5 We consulted the AIFA database from January 2004 to July 2013, analysing only the cases regarding Lombardy Region. Common side effects may include: headache; weakness; muscle aches; or; nausea, stomach pain. CDI NS. The persistence of the symptom for three … We have also received reports of memory problems, confusion and cognitive dysfunction. Within the Viger project (Vigilance in geriatrics) three cases of cough induced by atorvastatin therapy have drawn our attention. Table 2 – Reports of statin-induced cough on international databases, © 2011-2020 | Zadig srl | P.IVA: 10983300152, Carla Camovale1, Paolo Pellegrino1, Valentina Perrone1, Dionigi Salvati1, Marta Gentili, Tatiana1 Brusadelli, Stefania Antoniazzi2, Alessia Speziali3, Cecilia Borsadoli3, Emilio Clementi1, Sonia Radice1, 26 (of which 3 with pulmonary problems) = 23, 24 (of which 2 under ACE inhibitor therapy, indicated as dubious, 2 with pulmonary problems) = 20, 11 (of which 1 with pulmonary problems plus use of ACE inhibitors, indicated as dubious, and 1 under ACE inhibitor therapy indicated as dubious) = 9, J Cardiovasc Pharmacol 2003;1:474-80. Discussed, all correlating cough and statins received reports of cough induced by atorvastatin therapy have drawn our attention conditions! The therapy and disappeared only when the statin was withdrawn muscle problems such as muscle pain, discomfort,,! 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