The HMG-CoA reductase inhibitors - New safety concerns?

Use of the cholesterol-lowering HMG-CoA reductase inhibitors (or 'statins') has been associated with significant reductions in mortality and morbidity from coronary heart disease. In a number of large-scale clinical trials HMG-CoA reductase inhibitors have been shown to be well tolerated, with a low rate of serious adverse events. Safety concerns have been raised by the withdrawal of cerivastatin from most markets in August 2001. Cases of fatal rhabdomyolysis reported in patients receiving cerivastatin were in many cases associated with inappropriately high starting doses. Combination with the fibric acid derivative gemfibrozil was also a factor. While rhabdomyolysis has been reported with all HMG-CoA reductase inhibitors, it is rare and not usually fatal. The nature and/or incidence of toxicity reported with cerivastatin appears to be different from that associated with other agents in this class.