Simvastatin- and Fluvastatin-Associated Nightmares

Abstract

The authors present a case of nightmares induced by the 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors simvastatin and fluvastatin. A 79-year-old Caucasian male initially treated with simvastatin 10 mg every evening developed nightmares after the dose was increased to 40 mg. No relief was provided with a dose reduction to 20 mg, and simvastatin was held. Simvastatin was restarted 7 weeks later at 10 mg, with no complaints of nightmares until the dose was escalated to 20 mg. Simvastatin therapy was subsequently stopped. One month later, fluvastatin 80 mg was initiated and nightmares returned within 3 months, necessitating discontinuation of fluvastatin. The patient was rechallenged with fluvastatin 80 mg, and the nightmares returned 1 month later. Statin therapy was discontinued, and the patient was started on ezetimibe 10 mg. Lipophilic statins such as atorvastatin, lovastatin, and simvastatin have been associated with sleep disturbances. However, lipophilicity may not predict the likelihood of these adverse effects among the statins. Patients prescribed a statin should be counseled on sleep disturbances as potential adverse effects and should be encouraged to notify their providers if these disturbances develop.