Necrotizing myopathy:
Cholesterol lowering medication: HMG-CoA reductase (statins), fibric acid derivatives, niacin, ezetimibe
Red yeast rice (Monascus purpureus), a supplement used for its lipid-lowering effect, has also been reported to cause myopathy, including rhabdomyolysis.
Cyclosporine, labetalol, propofol, alcohol
Amphiphilic:
Chloroquine, hydroxychloroquine, amiodarone
Antimicrotbular:
Colchicine, vincristine
Mitochondrial myopathy:
Zidovudine and other HIV related antiretrovirals
Inflammatory myopathy:
L-tryptophan, d-penicillamine, cimetidine, L-Dopa, phenytoin, lamotrigine, alpha-interferon, TNF-alpha blockers, hydroxyurea, Imatinib.
TNF-apha blockers can induce other autoimmune disorders such as SLE and autoimmune neuropathies - demyelinating (MMN, AIDP) besides CNS demyelination. Patients with myositis are reported to have developed an inflammatory myopathy while on TNF-alpha blockers
Imatinib mesylate (Gleevec) is a tyrosine kinase inhibitor used to treat patients with CML. Myalgias, PM. These normalize with discontinuation of the drug and a course of corticosteroids.
Immune-checkpoint inhibitors.
Hypokalemic myopathy:
Diuretics, laxatives, amphotericin, lithium, toluene abuse, licorice, corticosteroids, alcohol abuse.
Critical illness myopathy:
Corticosteroids, non-depolarizing neuromuscular blocking agents.
Unknown:
Omeprazole, isotretinoin, finasteride, emetine, febuxostat, levetiracetam.
Chronic alcoholism
Immune checkpoint inhibitors, increasingly used in the treatment of advanced cancer, have recently been associated with the development of inflammatory myositis besides MG, AIDP, transverse myelitis and others.
Features That Raise Suspicion for a Toxic Myopathy
Clinical Features
Concomitant polyneuropathy (ie, a neuromyopathy): Amiodarone, Chloroquine/hydroxychloroquine, Colchicine, Telbivudine
Concomitant myasthenia gravis: Immune checkpoint inhibitors
Acute, painful myopathy: Statins, Other lipid-lowering agents, Cyclosporine, Labetalol Alcohol (with binge drinking).
EMG Features
Myotonic discharges: Chloroquine/hydroxychloroquine, Colchicine, Cyclosporine, Fibrates, Statins
Normal EMG in a patient with clinically suspected myopathy: Corticosteroids, Chronic alcoholic myopathy
Muscle Biopsy Features
Vacuoles: Amiodarone, Chloroquine/hydroxychloroquine, Colchicine.
Mitochondrial abnormalities (eg, many ragged red and cytochrome oxidase–negative fibers): Nucleoside-analogue reverse transcriptase inhibitors (eg, zidovudine)
Type 2 fiber atrophy: Corticosteroids, Chronic alcoholic myopathy
Sarcolemmal major histocompatibility complex 1 and membrane attack complex expression on non-necrotic fibers: Anti–3-hydroxy-3-methylglutaryl coenzyme A reductase myopathy associated with statins, Immune checkpoint inhibitors, D-Penicillamine.
Drugs Associated With an Increased Risk of Statin Muscle Toxicity
Amiodarone
Azole antifungals
Calcium channel blockers
Colchicine
Cyclosporine
Ezetimibe
Fibrates (eg, gemfibrozil)
Niacin
Protease inhibitors
Rapamycin
Sirolimus
Excessive intake of grapefruit juice
Sertraline is associated with mitochondrial dysfunction and hepatotoxicity. SSRIs inhibit a voltage-dependent anion channel in the pore of the mitochondrial inner membrane permeability transition (MPT), causing MPT induction and mitochondrial swelling. Sertraline also uncouples mitochondrial respiratory complexes I and V with adenosine triphosphate (ATP) depletion and energy failure. Moreover, sertraline induces the mitogen-activated protein kinase (MAPK) signaling pathway, activating both intrinsic and extrinsic caspase-dependent apoptotic pathways.