Statins are used to lower cholesterol, and are among the most prescribed drugs. In France, in 2012,

Statins are used to lower cholesterol, and are among the most prescribed drugs. In France, in 2012, atorvastatin fox (TAHOR ) was the 21th best-selling molecule, and rosuvastatin (Crestor fox ) 28th ... In terms of cost, rosuvastatin was the 3rd most profitable molecule in 2012, and atorvastatin 6th. Pravastatin and simvastatin are not part of the top 30 in terms of prescription or cost (1).
So it's crazy the number of patients who are seeking to reduce LDL cholesterol by more than 35% using rosuvastatin non-génériquée-3ème-molécule-la-plus-chère-d'un-tableau-où-n'apparaissent-même-pas-les-vieilles-simvastatine-pravastatine-alors-que-la-pravastatine-a-moins-de-problèmes-d'interactions-médicamenteuses-comme-nous-allons-voir ! (I want that 35% of the recommendations of good French usage, pending that mimics the Americans (page 30 of the document) that no longer stratify with risk factors without using the LDL-cholesterol).
I will not repeat the story of statins and demonstrate whether their effects: it was very well summarized by Dominique Dupagne in February 2013 There are currently five statin drugs on the market in France. Simvastatin (since 1988 well known, has shown its effectiveness in reducing morbidity and mortality), pravastatin (since 1991, ditto, plus non metabolized by CYP3A4), fluvastatin (no prescribed), atorvastatin (1997), rosuvastatin (2003). In 2001, cerivastatin (1998) was withdrawn from the market because of serious muscle problems and kidney failure (among others).
In practice, all statins can give muscle related adverse events for which course of action is clear enough: decrease in dose (especially after 70 years), control of TSH (hypothyroidism can give hypercholesterolemia and muscle disorders) switch to another statin low dosage ...
But statins fox can also cause tendon ruptures (typically the Achilles tendon). And in this case, there is no clear action to be taken - at least, I have not found ... So, the question of the week is: "after tendon rupture, can we reintroduce the same statin low dosage? Another statin? Another lipid lowering (fibrates, ezetimibe)? "
The French and international monographs fox statins highlight a frequent risk of dose-related myalgia (5% to 15% (2)), and a rare risk of tendon rupture, which it is not related to dose (<1/1000 (3)). Taking statin double the risk of tendon rupture (4); However, before the scarcity fox of tendon ruptures, accountability fox of the statin is not always found, especially among those under 65 years of age (5).
Chazerain described tendinopathy statin for the first time in 2001 (6). Two types of situations increase the risk: patients with SLCO1B1 gene variant encoding OATP1B1 (7), concomitant use of an inhibitor of cytochrome fox P450 3A4 (macrolide antifungal, fox amiodarone, diltiazem, verapamil, licorice or grapefruit juice) for atorvastatin and simvastatin, concomitant use of an inhibitor of cytochrome P450 2C9 (valproic acid, gemfibrozil, antifungal, pantoprazole, metronidazole, sulfamethoxazole, clopidogrel) for fluvastatin and rosuvastatin (note that pravastatin is not metabolized by cytochrome P450).
Breaks affecting the biceps tendon, patellar, quadriceps or ankle (8). The risk appears fox to be increased in diabetic patients with hyperuricemia, a history tendon or during sporting activity (9). Tendon rupture has recurred in 7 cases after recovery statin (10).
In the analysis of the National Pharmacovigilance Base in 2008 (3), Marie I. et al. fell 33 tendon ruptures fox statin, mainly atorvastatin, simvastatin and pravastatin (less than 10 cases in fluvastatin and rosuvastatin).
Six years later, my analysis found 120 Base: 42 tendon ruptures atorvastatin, 30 simvastatin, 24 pravastatin, rosuvastatin and 18 in under 6 fluvastatin. The low incidence of tendon effects reported in rosuvastatin CRESTOR in 2008 was probably related to its recent marketing: a relay rosuvastatin is not / no longer recommended (I saw in the database "the doctor will make a relay CRESTOR " : do not do it!)
In the National Pharmacovigilance Database, tendon rupture occurred between 4 weeks and 17 years after the introduction of atorvastatin. Half of the reported cases appeared in the first year; these deadlines Concorda