Distribution of drugs
1106 cases of DAMAR involved 114 drugs. Drugs distributed in nervous
system, antiinfectives for systemic use and cardiovascular system
mainly.
A large portion of DAMAR were associated with neurologic medications, up
to 21.07%. Most drugs in this kind were proved muscular toxic by random
clinical trials and clinical practice, which were also written in their
labels. Mechanism of antiepileptics caused DAMAR is interference of
mitochondrial impairment, while psycholeptics and analgesics leads to
muscle cell necrotizing by hypoxia [21].
Antiinfectives for systemic use were also the cause of DAMAR in many
cases. Despite the relatively large volume of case-based evidence, the
pathophysiology of fluoroquinolone-induced muscle adverse reaction is
still unclear. The inhibitory effect on the formation of oxygen-derived
reactive molecules [22] might be a reason.
Linezolid-induced muscle adverse reaction is associated with maintenance
of substantial mitochondrial function [23].
Cardiovascular system drug, especially statins of lipid modifying
agents, was known to be muscle toxic. Statins alone accounted for 8.86%
of all suspected drugs in our study. It is reported that gene
regulation, mitochondrial disfunction, immunologically mediation and
other mechanisms are associated with SMAS [24].
Concomitant drugs may interact and influence risk of muscle symptoms by
CYP3A4 and other elimination process way [25]. The
incidence of SAMS was estimated at 1-2% by national lipid association[26], while serious muscle injury, including
rhabdomyolysis was estimated at under 0.1% in general patient
population by the American heart association [4].
Incidence from our study is consistent with these studies above.