CDI NS, Am J Physiol Heart Circ Physiol 2006;290:1960-8. difficult, burning, or painful urination. Case 1. Rosuvastatin belongs to a group of medicines called HMG-CoA reductase inhibitors, or statins. In particular, inhaled PGE2 can induce cough as a result of an important increase of cough reflex sensitivity itself, by binding to specific receptor molecules.4,5 All patients were in good health and the temporality of the events induced the physician who reported the cases to impute the adverse reaction to the statin exclusively. The most common side effects may include: Headache, muscle aches and pains, abdominal pain, weakness, and nausea Additional side effects that have been reported with CRESTOR include memory loss and confusion Tell your doctor if you have any side … increased thirst. In conclusion, the possible mechanisms by which statins stimulate cough are linked to increased induction of COX-2 and NOS expression followed by increased nitric oxide and prostaglandins production, which in turn enhance cough reflex sensitivity.9. documented COX-2 induction and higher PGI2 production in human aortic smooth muscle cells following metavastatin and lovastatin administration.3 The duration of the sartan therapy had not been specified; anyway the physician who reported the adverse reaction ascribed it only to atorvastatin, since the patient had never manifested cough before its introduction. Case 3. Also in this case, the objective examination and the clinical history of the patient suggested the iatrogenic nature of the event. CDI NS. Case 2. The highest number of reports for iatrogenic cough is associated to rosuvastatin (425), followed by atorvastatin (344) and by simvastatin (144), probably caused by higher prescription rate for these drugs; lovastatin (9 cases) and cerivastatin (2 cases) have been associated to the lowest number of cases. It is a known side effect of Crestor. Posted By Anonymous in askapatient.com on September 16, 2014 @ 12:00 am “ Side Effects: Dry throat in morning, occasional dry cough. We found five reports, including the three cases previously discussed, all correlating cough and statins. Exceptional cases of interstitial pulmonary disease have been reported for some statins, especially in long-term therapies; nevertheless, cough without pulmonary involvement is not yet included in the data-sheet for statins. The patient was then successively treated with fibrates, without presenting similar conditions anymore. Analysis of the reports relative to Lombardy Region collected by the AIFA database. Suspect reports of “cough” by statins have been collected based on the MedDRA codex (Medical Dictionary for Regulatory Activities).1 Only for the Canadian and Australian reports it was possible to exclude the patients affected by pulmonary pathologies or in therapy with other suspect drugs known for causing cough and possibly implicated in the onset of the adverse reaction, therefore the total result might be overestimated (Table 2). In all these reports the statin was considered the only suspect drug (Table 1). The iatrogenic nature of the event was therefore hypothesised and atorvastatin ascribed as only suspect drug for the onset of the adverse reaction. As mentioned earlier, some people experience no side effects whatsoever. Cases of statin-induced cough in the Italian National Network for Pharmacovigilance relative to Lombardy Region (January 2004 – July 2013), Analysis of the international databases. A second hypothesised mechanism, probably involved in the potentiation of the prostaglandin-mediated action, is correlated to the effect caused by these drugs on the transmission way of nitric oxide (NO). Awareness about this correlation can be useful both to the physician – for providing a correct differential diagnosis and rationally establishing the possible iatrogenic nature of the cough – and the patient, who - knowing this possible adverse effect - could report its onset to the physician avoiding useless ulterior prescriptions. We worry about cataracts, elevated blood sugar and nerve pain. Nausea 4. Although not all of these side effects may occur, if they do occur they may need medical attention. A 70 years old woman, with hypercholesterolemia, treated with 40 mg/day of atorvastatin; two days after the beginning of the therapy she manifested dry cough. increased hunger. If experienced, these tend to have a Severe expression 1. Also in this case the patient anamnesis did not suggest any alternative explanation. The persistence of the symptom for three more days led to the drug withdrawal with consequent definitive remission of the cough. flushed, dry skin. Besides, increased inducible nitric oxide synthase (iNOS) expression, associated to stabilisation and potentiation of statin-mediated COX-2 activity, promotes significant cardioprotective effects.8 Recent results indicates that NO produced by NOS is an important stimulator in the normal cough reflex circuit, determining increased sensitivity of this reflex. increased urination. Our analysis considered as potential confounding factors pulmonary pathologies and concomitant drugs known for causing cough as possibly implicated in the onset of the adverse reaction. The highest number of reports for iatrogenic cough is associated to rosuvastatin (425), followed by atorvastatin (344) and by simvastatin (144), probably caused by higher prescription rate for these drugs; lovastatin (9 cases) and cerivastatin (2 cases) have been associated to the lowest number of cases. Persistent cough continued for 7 days during the therapy and disappeared only when the statin was withdrawn. Hypotheses on the onset of cough induced by statins, Statins are involved in the production of prostacyclin (PGI2) and prostaglandins (PG) and in the upregulation of enzyme cyclooxygenase-2 (COX-2). For mevastatin and pivastatin, on the other side, we did not find similar reports.