A 45-year-old woman who is being treated for hypertension and hypercholesterolemia develops diffuse muscle pain and weakness. Her serum creatine kinase activity is increased. Which of the following drugs is most likely to have caused this clinical picture?
Captopril
Hydrochlorothiazide
Lovastatin
Nicotinic acid
Propranolol
Correct answer
Lovastatin
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correct answer: C
This patient may be developing rhabdomyolysis - a very serious complication involving muscle necrosis and release of cellular contents into the bloodstream. Clinical signs include diffuse muscle pain, increased serum creatine kinase, elevated serum potassium, and acute renal failure - indicated by a rapidly rising creatinine level. Although rhabdomyolysis is a rare side effect, it has been associated with the administration of statins, such as lovastatin, especially when taken in combination with cyclosporine or fibrates. None of the other drugs listed above has been associated with rhabdomyolysis.