Statin Neuropathy
Treatment with statins, or HMG-CoA-reductase inhibitors, reduces the risk of cardiovascular disease in patients with hypercholesterolemia. Peripheral neuropathy has been reported to occur in patients treated with statins, in both case reports1–5 and population studies6–8 showing a statistically significant association. The neuropathy can occur with different statin medications,4,9 and long term exposure appears to increase the risk for developing neurotoxicity. Statin use can also aggravate a pre-existing neuropathy.7 The neuropathy can be partially reversed with drug cessation.6,9
Statin neuropathy appears to be associated with axonal degeneration, and affects both large and small fibers. Small fiber neuropathy (SFN) may be an early manifestation, and involve both sensory or autonomic fibers.10–12 Large fiber neuropathy can be identified in routine nerve conduction studies, but diagnosis of small fiber neuropathy requires demonstration of reduced epidermal or sweat gland nerve fiber density on punch skin biopsy. In a recent study of SFN, Novak and colleagues reported that patients who were treated with statins appeared to have a non-length dependent neuropathy.12
Patients who are intolerant of statins, due to development of neuropathy or other complications, can be treated with newer, non-statin lipid lowering agents that have not been reported to be associated with peripheral neuropathy.
- Ahmad S. Lovastatin and peripheral neuropathy. Am Heart J. 1995;130(6):1321. [PubMed]
- Jacobs M. HMG-CoA reductase inhibitor therapy and peripheral neuropathy. Ann Intern Med. 1994;120(11):970. [PubMed]
- Jeppesen U, Gaist D, Smith T, Sindrup S. Statins and peripheral neuropathy. Eur J Clin Pharmacol. 1999;54(11):835-838. [PubMed]
- Ziajka P, Wehmeier T. Peripheral neuropathy and lipid-lowering therapy. South Med J. 1998;91(7):667-668. [PubMed]
- Phan T, McLeod J, Pollard J, Peiris O, Rohan A, Halpern J. Peripheral neuropathy associated with simvastatin. J Neurol Neurosurg Psychiatry. 1995;58(5):625-628. [PMC]
- Backes J, Howard P. Association of HMG-CoA reductase inhibitors with neuropathy. Ann Pharmacother. 2003;37(2):274-278. [PubMed]
- de L, van P. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med. 2006;64(9):334-338. [PubMed]
- Gaist D, Jeppesen U, Andersen M, García R, Hallas J, Sindrup S. Statins and risk of polyneuropathy: a case-control study. Neurology. 2002;58(9):1333-1337. [PubMed]
- Chong P, Boskovich A, Stevkovic N, Bartt R. Statin-associated peripheral neuropathy: review of the literature. Pharmacotherapy. 2004;24(9):1194-1203. [PubMed]
- Boger M, Hulgan T, Donofrio P, Peltier A. QSART for diagnosis of statin-associated polyneuropathy. Muscle Nerve. 2011;43(2):295-296. [PubMed]
- Lo Y, Leoh T, Loh L, Tan C. Statin therapy and small fibre neuropathy: a serial electrophysiological study. J Neurol Sci. 2003;208(1-2):105-108. [PubMed]
- Novak P, Pimentel D, Sundar B, Moonis M, Qin L, Novak V. Association of Statins with Sensory and Autonomic Ganglionopathy. Front Aging Neurosci. 2015;7:191. [PMC]
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Statin Neuropathy
Treatment with statins, or HMG-CoA-reductase inhibitors, reduces the risk of cardiovascular disease in patients with hypercholesterolemia. Peripheral neuropathy has been reported to occur in patients treated with statins, in both case reports1–5 and population studies6–8 showing a statistically significant association. The neuropathy can occur with different statin medications,4,9 and long term exposure appears to increase the risk for developing neurotoxicity. Statin use can also aggravate a pre-existing neuropathy.7 The neuropathy can be partially reversed with drug cessation.6,9
Statin neuropathy appears to be associated with axonal degeneration, and affects both large and small fibers. Small fiber neuropathy (SFN) may be an early manifestation, and involve both sensory or autonomic fibers.10–12 Large fiber neuropathy can be identified in routine nerve conduction studies, but diagnosis of small fiber neuropathy requires demonstration of reduced epidermal or sweat gland nerve fiber density on punch skin biopsy. In a recent study of SFN, Novak and colleagues reported that patients who were treated with statins appeared to have a non-length dependent neuropathy.12
Patients who are intolerant of statins, due to development of neuropathy or other complications, can be treated with newer, non-statin lipid lowering agents that have not been reported to be associated with peripheral neuropathy.
- Ahmad S. Lovastatin and peripheral neuropathy. Am Heart J. 1995;130(6):1321.[PubMed]
- Jacobs M. HMG-CoA reductase inhibitor therapy and peripheral neuropathy. Ann Intern Med. 1994;120(11):970.[PubMed]
- Jeppesen U, Gaist D, Smith T, Sindrup S. Statins and peripheral neuropathy. Eur J Clin Pharmacol. 1999;54(11):835-838.[PubMed]
- Ziajka P, Wehmeier T. Peripheral neuropathy and lipid-lowering therapy. South Med J. 1998;91(7):667-668.[PubMed]
- Phan T, McLeod J, Pollard J, Peiris O, Rohan A, Halpern J. Peripheral neuropathy associated with simvastatin. J Neurol Neurosurg Psychiatry. 1995;58(5):625-628.[PMC]
- Backes J, Howard P. Association of HMG-CoA reductase inhibitors with neuropathy. Ann Pharmacother. 2003;37(2):274-278.[PubMed]
- de L, van P. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med. 2006;64(9):334-338.[PubMed]
- Gaist D, Jeppesen U, Andersen M, García R, Hallas J, Sindrup S. Statins and risk of polyneuropathy: a case-control study. Neurology. 2002;58(9):1333-1337.[PubMed]
- Chong P, Boskovich A, Stevkovic N, Bartt R. Statin-associated peripheral neuropathy: review of the literature. Pharmacotherapy. 2004;24(9):1194-1203.[PubMed]
- Boger M, Hulgan T, Donofrio P, Peltier A. QSART for diagnosis of statin-associated polyneuropathy. Muscle Nerve. 2011;43(2):295-296.[PubMed]
- Lo Y, Leoh T, Loh L, Tan C. Statin therapy and small fibre neuropathy: a serial electrophysiological study. J Neurol Sci. 2003;208(1-2):105-108.[PubMed]
- Novak P, Pimentel D, Sundar B, Moonis M, Qin L, Novak V. Association of Statins with Sensory and Autonomic Ganglionopathy. Front Aging Neurosci. 2015;7:191.[PMC]
Related Articles
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Becky Tsai2022-09-05T17:51:25-05:00
Bakkers et al examined a total of 265 patients diagnosed with small fiber neuropathy (SFN). They found that SFN was associated with a severe impairment in Quality of Life...[Read More]
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Becky Tsai2022-09-05T17:52:41-05:00
Therapath LLC has established normative values for two upper limb body sites that can now be used to evaluate 3mm punch skin biopsy specimens...[Read More]
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Becky Tsai2022-09-05T17:55:36-05:00
Neuropathy Digest Volume III. Selections include: Reduced nerve fiber density in patients with fibromyalgia, and mononeuropathy in complex regional pain syndrome (CRPS). [Read More]
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Becky Tsai2022-09-05T17:56:38-05:00
Neuropathy Digest Volume II. Selections include: POTS and reduced epidermal nerve fiber density (ENFD), and muscle cramps in diabetes. [Read More]