Myalgia Side Effect
Myalgia (muscle pain or aching) is characterised by diffuse muscle pain, tenderness and cramps.
Common drugs which most frequently induce myalgia are fluoroquinilones, corticosteroids, statins, fibrates, antimalarials, diuretics3, corticosteroids, drugs causing hypokalaemia, immunosuppressants. Certain combinations of drugs (e.g. cyclosporin and colchicine) can induce severe muscle diseases5, 6.
Statins are among the most well-recognized myotoxic drugs. Muscle aches, cramps and weakness can occur in up to 25% of patients taking statins1, 2. Statin-induced muscle adverse effects may be exacerbated by exercise. A possible mechanism of statin induced myopathy is a decrease in coenzyme Q10, a product of the mevalonate pathway.
Drugs, that have been reported to cause muscle pain:
Drug | Incidence |
---|---|
Abelcet | |
Abilify | > 2% |
Accolate | 1.6% |
Accupril | 1.5% |
Accuretic | 2.4% |
Aceon | 0.3% to 1.1% |
Aciphex | |
Actimmune | 6% |
Actiq | < 1% |
Activella | |
Actonel | 4.6% to 6.6% |
Actos | 5.4% |
Adalat | < 1% |
Advicor | 3% |
Aggrenox | 1.2% |
Agrylin | 1% to 5% |
Aldara | 1% to 1.4% |
Aldoclor | |
Aldoril | |
Alferon N | < 45% |
Alinia | < 1% |
Altace | < 1% |
Altoprev | 3% |
AmBisome | 2% to 10% |
Ambien | 1% to 7% |
Amevive | > 2% |
Amiodarone (Cordarone®)5 | |
Anaprox | < 1% |
Aranesp | 8% to 21% |
Arava | 1% to 3% |
Aredia | 26% |
Arimidex | 2% to 5% |
Asacol | 3% |
Astelin | 1.5% |
Atacand | > 0.5% |
Augmentin | |
Avalide | |
Avapro | > 1% |
Avelox | 0.11% to 3% |
Avonex | 29% |
Axert | Infrequent |
Axid | 1.7% |
Azasan | |
Azmacort Inhalation Aerosol | 1% to 3% |
Beconase | |
Benicar | > 0.5% |
Betaseron for SC | 27% |
Bextra | 1.9% to 2% |
Biltricide | |
Brimonidine Tartrate | 3% to 9% |
Busulfex I.V. | 16% |
Caduet | 0.1% to 5.6% |
Calcijex | |
Calcium Disodium Varsenate | |
Campath | 11% |
Campral | < 10% |
Cancidas | < 3.1% |
Captopril | |
Carbatrol | |
Casodex | 5% |
Catapres | < 0.6% |
Celebrex | 0.1% to 1.9% |
Celexa | 2% |
CellCept | 3% to < 20% |
Cenestin | 3.8% to 28% |
Cialis | 1% to 4% |
Clarinex | 3% |
Clinoril | < 1% |
Clomid | |
Clorpres | 0.6% |
Clozapine | 1% |
Clozaril | 1% |
Colazal | 1% |
Combivir | 8% |
Copaxone | > 2% |
Copegus | 40% |
Cosmegen | |
Coumadin | |
Cozaar | > 1% |
Crestor | 2.8% |
Crinone | 8% |
Cubicin | < 1% |
Cymbalta | 1% to 4% |
Cytovene | |
DTIC-Dome | Infrequent |
Dantrium | |
Demadex | 1.6% |
Depacon | 1% to 5% |
Depakene | 1% to 5% |
Depakote | 1% to 5% |
Desferal Vials | |
DiaBeta | |
Diovan | |
Diprivan Injectable Emulsion | < 1% |
Dolobid | < 1% |
Dostinex | 2% |
Doxil | 1% to 5% |
Dyazide | |
EC-Naprosyn | < 1% |
Effexor | |
Eligard | 2.2% |
Eloxatin | 2% to 5% |
Emend | > 0.5% |
Emtriva | 4% to 6% |
Engerix-B | < 1% |
Epivir-HBV | 14% |
Epivir | 8% |
Epogen | Rare |
Evista | 7.7% |
Evoxac | 1% to 3% |
Exelon | Frequent |
Factive | < 0.1% |
Faslodex | < 1% |
FazaClo | 1% |
Ferrlecit | > 1% |
Flexeril | Rare |
Flolan | 3% to 44% |
Flovent | 1% to 3% |
Floxin | < 1% |
Fludara | 4% to 16% |
Flumist | 5% to 16.7% |
Fortovase | < 2% |
Fosamax | 0.4% to 6% |
Furosemide | |
Fuzeon | 5% |
Gabitril | 1% to 5% |
Gamimune N | |
Gastrocrom | 3.4% |
Gengraf | 1% to 3% |
Genotropin Lyophilized Powder | |
Geodon | 1% |
Gleevec | 0.2% to 38.6% |
Glucotrol | < 3% |
HIVID | 0.4% |
Havrix Vaccine | < 1% |
Hectorol, | |
Humatrope Vials and Cartridges | 9.1% to 24.3% |
Hytrin | > 1% |
Hyzaar | |
Imitrex | 1.8% |
InFeD | |
Infergen | 51% to 58% |
Intal Inhaler | Rare |
Intron A | 3% to 75% |
Invirase | 0.3% to 2% |
Isotretinoin (Accutane®)3 | |
Jantoven | |
Kaletra | < 2% |
Klonopin | 1% |
Lamictal | > 1% |
Lamisil | |
Lariam | 1% to 10% |
Lescol | 3.8% to 5% |
Leukine | 18% |
Leustatin | 7% |
Levaquin | 0.1% to 1% |
Levitra | < 2% |
Lexapro | |
Lipitor | < 5.6% |
Lofibra | |
Lotensin | < 1% |
Lotrel | |
Lotronex | Rare |
Lupron | 5% to 8.2% |
M-M-R II | |
Marinol | < 1% |
Matulane | |
Mavik | 4.7% |
Maxalt | < 1% |
Maxzide | |
Meridia | 1.9% |
Meruvax II | |
Mevacor | 1.8% to 2.4% |
Miacalcin | 1% to 3% |
Micardis | 1% |
Mirapex | > 1% |
Monurol Sachet | < 1% |
Myfortic | 3% to 20% |
Mylotarg | 3% to 11% |
Nabi-HB | 10% |
Naprosyn | < 1% |
Naropin | < 1% |
Nasonex | > 2% |
Navelbine | < 12% |
Neoral | 1% to 3% |
Neulasta | 15% to 72% |
Neumega | > 10% |
Niaspan | |
Nimotop | < 1.4% |
Nipent | 11% to 19% |
Norditropin Cartridges | |
Noroxin | |
Norvasc | 0.1% to 1% |
Norvir | 1.7% to 2.4% |
Oncaspar | 1% to 5% |
Ontak Vials | 17% |
OptiPranolol Metipranolol | |
Orap | 2.7% |
Orthoclone OKT3 | < 1% |
PEG-Intron | 54% |
Paxil | 2% |
Pegasys | 37% |
Pentasa | < 1% |
Pepcid | Infrequent |
Periostat | 1% |
Permax | 1.1% |
Persantine | Rare |
Pletal | 2% to 3% |
Pneumovax 23 | |
Pravachol | 0.6% to 2.7% |
Premarin | 5% to 9% |
Premphase | 4% to 5% |
Prempro | 4% to 5% |
Prevacid | < 1% |
Prevpac | 1% to 3% |
Prilosec | < 1% |
Prinivil | 0.3% to 1% |
Prinzide | 0.3% to 1% |
ProSom | Infrequent |
Prochieve | |
Procrit | Rare |
Prograf | 3% to 15% |
Proleukin | 6% |
Prometrium | < 5% |
Protonix I.V. | < 1% |
Protonix | < 1% |
Protopic | < 3% |
Provigil | > 1% |
Prozac | |
Pulmicort | 1% to 3% |
Rabies Vaccine RebAvert | 53% |
Rapamune | 3% to 20% |
Raptiva | 8% |
ReFacto Vials | |
Rebetol | 32% to 64% |
Rebetron | 61% to 64% |
Rebif | 25% |
Recombivax | < 1% |
Relenza Rotadisk | < 1.5% |
Relpax | Infrequent |
Remicade for I.V. | |
ReoPro Vials | 0.3% |
Requip | > 1% |
Rescriptor | |
Retrovir | 8% |
Reyataz | < 3% |
RhoGAM Ultra-Filtered | |
Ribavirin | 50% to 64% |
Rifater | |
Risperdal | < 5% |
Rituxan | 7% |
Rocaltrol | |
Roferon-A | 51% to 73% |
Rythmol | |
Salagen | 1% to 2% |
Sandimmune | < 2% |
Sandostatin | < 18% |
Sensipar | 15% |
Septra | |
Serevent Diskus | 1% to 3% |
Simulect | 3% to 10% |
Sonata | > 1% |
Soriatane | 1% to 10% |
Spectracef | 0.1% to 1% |
Spiriva HandiHaler | 4% |
Sporanox | 1% to 3% |
Strattera | 3% |
Stromectol | 0.4% |
Sular | < 1% |
Suprane | < 1% |
Sustiva | < 2% |
Synercid I.V. | < 1% |
Synvisc | |
Tagamet | Rare |
Tambocor | < 1% |
Targretin | |
Tarka | > 0.3% |
Tasmar | 1% to 10% |
Taxotere | 1% to 21.1% |
Tegretol | |
Temodar | 5% |
Tequin | < 0.1% |
Teveten | > 1% |
Thalomid | |
Tiazac | 2% |
Timentin | |
Timolide | < 1% |
Tindamax | |
Topamax | 2% |
Toprol-XL | |
Toradol | |
Tricor | |
Trisenox | 25% |
Trizivir | 8% |
Truvada | |
Twinrix | < 1% |
Uniretic | < 1% |
Univasc | 1.3% |
VFEND | < 1% |
Vantin | < 1% |
Vaqta | 1.9% |
Varivax | > 1% |
Vaseretic | |
Vasotec I.V. | 0.5% to 1% |
Velcade | 14% |
Vesanoid | 14% |
Viagra | < 2% |
Vicoprofen | < 1% |
Videx EC | |
Voriconazole (Vfend®)7 | |
Viracept | < 2% |
Viramune | |
Viread | 3% to 4% |
Vivelle | |
Vytorin | 3.5% |
Welchol | 2% |
WinRho | |
Xalatan | 1% to 2% |
Xanax | 1.5% |
Xeloda | 5% to 9% |
Xenical | 4.2% |
Xifaxan | < 2% |
Xopenex | 1.5% |
YF-Vax | 10% to 30% |
Zantac | Rare |
Zegerid | < 1% |
Zelnorm | 1% |
Zemaira | 0.2% to 0.4% |
Zenapax for | 2% to 5% |
Zerit | 32% |
Zetia | 5% |
Zevalin | 7% |
Ziagen | |
Zocor | |
Zofran | 10% |
Zoladex | 3% |
Zoloft | 1% to 10% |
Zometa | 23% |
Zomig | 1% to 2% |
Zonegran | Infrequent |
Zosyn | < 1% |
Zovirax | |
Zyban | 2% to 4% |
Zyprexa | |
Zyrtec | < 2% |
Many medications can cause toxicity in muscle tissue, leading to significant muscle pain and sometimes morbidity. Myotoxic drugs can affect muscles through a variety of mechanisms by directly affecting muscle mitochondria, lysosomes, and myofibrillar proteins; altering muscle antigens and triggering an immunologic or inflammatory reaction; or by impairing the electrolyte or nutritional balance.
- 1. Parker BA, Thompson PD. Effect of statins on skeletal muscle: exercise, myopathy, and muscle outcomes. Exerc Sport Sci Rev. 2012 Oct;40(4):188-94. PubMed
- 2. Phillips PS, Haas RH, Bannykh S, Hathaway S, Gray NL, Kimura BJ, Vladutiu GD, England JD. Statin-associated myopathy with normal creatine kinase levels. Ann Intern Med. 2002;137(7):581–5.
- 3. Chroni E, Monastirli A, Tsambaos D. Neuromuscular adverse effects associated with systemic retinoid dermatotherapy. Drug Saf. 2010 Jan 1;33(1):25-34. PubMed
- 4. Greenberg A. Diuretic complications. Am J Med Sci. 2000 Jan;319(1):10-24. PubMed
- 5. Le Quintrec JS, Le Quintrec JL. Drug-induced myopathies. Baillieres Clin Rheumatol. 1991 Apr;5(1):21-38.
- 6. Finsterer J1. Medically induced myopathia. Nervenarzt. 2006 Jun;77(6):682-6, 688-93. PubMed
- 7. Wise SM, Wilson MA. A case of periostitis secondary to voriconazole therapy in a heart transplant recipient. PubMed
Published: September 07, 2016
Last updated: September 08, 2016