Risk of rhabdomyolysis by the concomitant use of vitamin supplements and HMG-CoA reductase inhibitors

Abstract

HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase (EC 1.1.1.34) inhibitors (statins) are used for hypercholestemia. HMG-CoA reductase is the rate-limiting enzyme of cholesterol biosynthesis. Rhabdomyolysis is one of the most serious side effects by statins. On the other hand, vitamins are used widely and easily for supplements of nutrition in daily use. Statins are one of the most marketable drugs for hypercholesterolemia. Vitamins are taken without prescription as supplements of nutrition ; the patient who prescribed statins may take vitamins. So the interaction with statins and vitamins were studied by using the in vitro assay system with L6 rat myoblasts. The myopathy was increased by the presence of vitamin A, vitamin D and nicotinic acid. Especially the severe injury was induced to the cells by vitamin A and vitamin D. The other vitamins, vitamin B₁, B₆, B₁₂, vitamin C and vitamin E did not show the reaction on the L6 cells. Taking vitamins together with statins increase the risk of rhabdomyolysis. The results of this study suggest that it is desirable for the person takes statins not to take vitamin A, vitamin D and nicotinic acid.