Health & Spirit

Extreme pain during prostate biopsy is unnecessary and inappropriate

By Keith Roach, M.D. on

Orlando, FL 32803

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DEAR DR. ROACH: In your recent column on rhabdomyolysis, I was surprised that you did not mention statin drugs. Because I did not do well on statins, my cardiologist prescribed Praluent, as I have atherosclerosis of my heart and other blood vessels. Praluent is a relatively new drug. Are you aware of it being associated with rhabdomyolysis? -- M.F.W.

ANSWER: Statin drugs can cause rhabdomyolysis, a severe and dangerous muscle breakdown. However, it is very rare -- a few cases per million prescriptions (muscle aches with statins are much more common but do not normally cause muscle damage).

Alirocumab (Praluent), given once weekly by injection, is one in a new class of drugs called PCSK9 inhibitors. They dramatically reduce LDL cholesterol, and also have been shown to reduce heart attack risk in people known to have atherosclerosis, cholesterol deposits in the arteries, especially in the heart. About 4 to 12 percent of people on this drug will develop muscle pain, but I could not find a case of rhabdomyolysis associated with Praluent or evolocumab (Repatha), another PCSK9 inhibitor. They can rarely cause allergic reactions.

There is no medication that is completely free of the possibility of side effects, but the risk must be weighed against the benefit. In the case of someone with known blockages in the arteries, the medications cause much more good than harm for the population. Unfortunately, any given individual may still have a bad effect.



Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from

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