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Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management.

Abstract：

:Statins, or 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors, such as lovastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, rosuvastatin and pitavastatin, are cholesterol-lowering drugs used in clinical practice to prevent coronary heart disease. These drugs are generally well tolerated and have been rarely associated with severe adverse effects (e.g. rhabdomyolysis). Over the years, case series and data from national registries of spontaneous adverse drug reaction reports have demonstrated the occurrence of neuropsychiatric reactions associated with statin treatment. They include behavioural alterations (severe irritability, homicidal impulses, threats to others, road rage, depression and violence, paranoia, alienation, antisocial behaviour); cognitive and memory impairments; sleep disturbance (frequent awakenings, shorter sleep duration, early morning awakenings, nightmares, sleepwalking, night terrors); and sexual dysfunction (impotence and decreased libido). Studies designed to investigate specific neuropsychiatric endpoints have yielded conflicting results. Several mechanisms, mainly related to inhibition of cholesterol biosynthesis, have been proposed to explain the detrimental effects of statins on the central nervous system. Approaches to prevent and manage such adverse effects may include drug discontinuation and introduction of dietary restrictions; maintenance of statin treatment for some weeks with close patient monitoring; switching to a different statin; dose reduction; use of ω-3 fatty acids or coenzyme Q10 supplements; and treatment with psychotropic drugs. The available information suggests that neuropsychiatric effects associated with statins are rare events that likely occur in sensitive patients. Additional data are required, and further clinical studies are needed.

journal_name

CNS Drugs

journal_title

CNS drugs

authors

Tuccori M,Montagnani S,Mantarro S,Capogrosso-Sansone A,Ruggiero E,Saporiti A,Antonioli L,Fornai M,Blandizzi C

doi

10.1007/s40263-013-0135-1

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

249-72

issue

eissn

1172-7047

issn

1179-1934

journal_volume

pub_type

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Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management.