Atorvastatin may cause nightmares
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7547.0-c (Published 20 April 2006) Cite this as: BMJ 2006;332:0-cAll rapid responses
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Since betablockers including atenolol are well known to give rise to
central nervous system side effects such as nightmares* perhaps statins
may be just enhancing this effect, in which case lowering the dose of
atenolol in this case or stopping or changing it may allow the patient to
continue benefitting from the use of statins.
*McAnish J, Cruishank JM
Beta-blockers and central nervous system side effects.
Pharmacol Ther. 1990;46(2):163-97. Review.
Competing interests:
None declared
Competing interests: No competing interests
Nightmare is a coronary-myocardium imbalance according to some authors
(1). It is based on a similar mechanism of an emotion and may produce
angina crisis and even acute coronary syndromes in cardiac patients. This
process is identified as decurrent of adenaline and noradrenaline release.
Parmar and Luque-Coqui found in 1998 (2) that an association between
dreams and sudden death is described in folklore and medical history, and
originates from the common experience of being awakened by vivid,
frightening dreams, with racing pulse, cold sweats and other physiological
responses associated with intense distress. Intense alterations in
autonomic activity during dreaming can have dire consequences in patients
with cardiovascular disease. They had four patients with no evidence of
underlying coronary artery disease, where emotional stress produced by
nightmares or 'deadly dreams' caused coronary artery dissection in two and
vasospasm in the other two, leading to life-threatening cardiac events.
Also they have speculated a possible mechanism for this relationship.
The case in discussion was in a 72 year old woman with a
history of longstanding hypertension, treated hypothyroidism, heart
failure, and chronic renal failure who developed nightmares five days
after taking atorvastatin for hypercholesterolaemia (3)
Carlos Monteiro
References:
1. Como Escapar da Cirurgia de Ponte de Safena e do Enfarte do Miocárdio
Só com Remédio, Q. H. de Mesquita, Book, Editora Ícone, 1991
2. Killer dreams, Parmar MS, Luque-Coqui AF. Can J Cardiol., 1998
Nov;14(11):1389-91
3. Atorvastatin may cause nightmares, Peter J H Smak Gregoor, BMJ
2006;332:950 (22 April), doi:10.1136/bmj.332.7547.950
Competing interests:
None declared
Competing interests: No competing interests
Was the patient taking the atorvastatin at night? It might be
worthwhile taking the drug in the morning instead.
Competing interests:
None declared
Competing interests: No competing interests
Statins affect tryptophan metabolism
The relation found between nightmares and intake of
atorvastatin may not necessarily refer to a direct effect of the drug on
the central nervous system. Besides their lipid-lowering activities,
statins such as atorvastatin exert immunomodulatory effects (1) as
observed by down-regulation of interferon-gamma mediated pathways
towards peripheral blood mononuclear cells (2). Among them a significant
inhibition of tryptophan-degrading enzyme indoleamine (2,3)-dioxygenase
upon statin treatment
was most apparent. Tryptophan is a precursor of serotonin, and limitation
of tryptophan availability negatively affects serotonin production. Thus,
the appearance of nightmares upon statin treatment could relate to
disturbances of serotonin availability caused by these drugs.
Katharina Schroecksnadel, Guenter Weiss, Dietmar Fuchs
Department of Internal Medicine and Division of Biological
Chemistry, Biocentre
Innsbruck Medical University, A-6020 Innsbruck, Austria
1. Kulmatycki KM, Jamali F. Drug disease interactions: role of
inflammatory mediators in disease and variability in drug response. J
Pharm Pharm Sci 2005;8:602-625.
2. Neurauter G, Wirleitner B, Laich A, Schennach H, Weiss G, Fuchs
D. Atorvastatin suppresses interferon-gamma- induced neopterin formation
and tryptophan degradation in human peripheral blood mononuclear cells and
in monocytic cell lines. Clin Exp Immunol 2003;131:264-267.
Competing interests:
None declared
Competing interests: No competing interests