Acute Muscular Syndrome Associated with Administration of Clofibrate

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Abstract
In 60 patients with hyperlipoproteinemia treated with clofibrate, five cases of elevated serum transaminase and creatine phosphokinase were observed. In two, severe myalgia, stiffness, weakness, and malaise coincident with drug administration developed. Cessation of therapy resulted in prompt resolution of symptoms. An identical clinical syndrome reappeared in one of these patients on rechallenge with clofibrate. Three patients had asymptomatic elevations in transaminase and creatine phosphokinase. In one case these abnormalities were clearly dose related. Usually, the abnormalities persisted throughout the period of therapy. In some cases, however, transaminase became normal but creatine phosphokinase remained elevated while treatment continued. Since creatine phosphokinase is absent from liver, these findings suggest that skeletal muscle is the major source of the elevated serum enzymes and that periodic examinations for evidence of muscle tenderness and dysfunction and frequent determinations of transaminase and creatine phosphokinase should be performed on all patients receiving clofibrate.