Exposure to sertraline and ranolazine is common among adult patients with genetically uncharacterized lipid storage myopathy

Background

To investigate sertraline and ranolazine exposure in adult patients with lipid storage myopathy (LSM), given recent reports of their potential association with the condition.

Methods

We reviewed electronic health records to identify adult patients with a pathological and/or genetic diagnosis of LSM, who were evaluated at the Mayo Clinic (January 2000–December 2021). Patients without genetic testing were excluded.

Results

We identified 10 patients with LSM, including 8 with multiple acyl-CoA dehydrogenase deficiency (MADD) and 2 with subacute LSM after ranolazine initiation. Genetic testing revealed an underlying molecular defect in only 3 MADD patients. Sertraline exposure was noted in 4 MADD patients, none of whom had an identified genetic defect. Muscle biopsy findings were similar across patients with hereditary MADD, sertraline-associated MADD, and ranolazine-associated LSM, all demonstrating excessive lipid accumulation and attenuation of succinate dehydrogenase reactivity. MADD patients showed a favorable response to riboflavin and coenzyme Q10 supplementation, regardless of genetic test results. Patients with ranolazine-associated LSM improved following discontinuation of the drug.

Conclusions

LSM is rare in adults but important to recognize due to its treatability and potential drug-induced cases in a significant proportion of patients. Weakness in individuals taking sertraline or ranolazine should prompt consideration of LSM.