Statin drugs are the drugs most commonly known to cause myopathy (a muscle wasting disease) at this time. Neuroleptics, proton pump inhibitors, gabapentin and chemicals from medicinal plants can cause myopathy. This study reviewed an Italian database of natural products to further learn about the hazards of using herbal medicines. The Naranjo probability scale was used to evaluate the adverse drug reactions (ADR.)
Over a 5 year period, nine reports of muscle abnormalities were reported by plant therapists. Two cases were reported by doctors. Four of the nine were due to red yeast rice (Monascus purpureus) and three were due to licorice (Glycyrrhiza glabra.) In all cases, the serum creatinine phosphokinase (CPK) was elevated. The highest CPK was associated with muscle pains and did not improve upon the discontinuation of the red yeast rice.
Rhabdomyolysis was diagnosed in one patient on licorice (30-40 g/day.) The rhabdomyolysis disappeared after the herb was discontinued. Hypertension, hypokalemia, hypernatremia and increased CPK blood levels resulted from 3 months of licorice juice used to treat chronic hypotension. This patient recovered, also.
Glycyrrhizic acid of licorice can impair lipid function in muscles. Red yeast rice contains mevalonic acid and Monacolin K which has the same activity as the statin drug, lovastatin. Red yeast rice is used to treat abnormal serum lipids.
Statin intolerance in a patient should suggest caution in the used of red yeast rice or licorice in that patient.
CONCLUSION: Red yeast rice and licorice can cause myopathy and should be used with caution by people who have had muscle reactions to statin drugs in the past.
NOTE: The Narnajo probability scale is an attempt to accurately determine whether an adverse (ADR) was due to the drug or herb used or due to other causes.
Rhabdomyolysis is the rapid breaking down of muscles fibers, releasing muscle enzymes, such as creatinine phosphokinase (CPK,) into the blood.
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