To the Editor:
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, are effective cholesterol-lowering agents that are among the most frequently prescribed medications. Statins are generally well tolerated, with most adverse side effects related to the gastrointestinal system (
1
). Although alopecia is listed as a potential adverse effect on package inserts, published reports documenting this adverse effect are scarce (2
, - Robb-Nicholson C.
Recently, I heard on a TV show that anticholesterol drugs can cause hair loss. I’ve been taking Zocor for about 18 months now, and in the past 6 months I’ve noticed hair loss from the top and sides of my head. Is this common? Will my hair regrow once I stop taking the drug?.
Harv Womens Health Watch. 1998; 5: 8
3
). We present a case of reversible alopecia attributed to atorvastatin (Lipitor, Pfizer, New York).- Lee T.H.
By the way, doctor . . . My hair has been thinning out for the past decade or so, but since my doctor started me on Lipitor (atorvastatin) a few months ago for high cholesterol, I swear it’s been falling out much faster. My doctor discounts the possibility, but I looked in the Physicians’ desk reference (PDR) and alopecia is listed under “adverse reactions.” What do you think?.
Harv Health Lett. 2000; 25: 8
A 38-year-old woman with no unusual past medical history was admitted to the hospital because of a 6-week history of progressive swelling. Blood pressure was 144/90 mm Hg, and the physical examination showed severe periorbital edema and peripheral pitting edema. Her albumin level was 1.7 g/dL, total serum cholesterol level was 660 mg/dL, and spot urine protein-to-creatinine ratio was 26. A renal biopsy specimen revealed a normal kidney under light and immunofluorescence microscopy, but electron microscopy revealed widespread effacement of the podocytes, indicating that the etiology of the patient’s nephrotic syndrome was minimal change disease. Therapy was begun with furosemide (40 mg), prednisone (60 mg), benazepril (10 mg), and atorvastatin (10 mg); all were administered orally, once daily. Clinical improvement with a marked reduction in proteinuria occurred over 4 weeks; therefore, furosemide was discontinued and prednisone dose was tapered. Total serum cholesterol level decreased to 270 mg/dL.
Two weeks later, the patient complained of progressive hair loss. Benazepril was continued to control proteinuria, but atorvastatin was discontinued because total serum cholesterol level had decreased to 160 mg/dL. Several weeks later, the patient reported that new hair growth had begun.
The nephrotic syndrome recurred 5 months later. Urinary protein excretion was nearly 20 g per day, and total serum cholesterol level was >600 mg/dL. Prednisone (60 mg daily) and atorvastatin (10 mg daily) were restarted, and within 2 weeks the patient complained again of excessive hair loss. Atorvastatin, but not prednisone, was stopped, and normal hair growth returned as another clinical remission occurred.
Three months later, while still being treated with benazepril, the patient relapsed, and steroid therapy was restarted, but without atorvastatin. Despite similar degrees of hypoalbuminemia, hypercholesterolemia, and proteinuria, abnormal hair loss did not occur during this relapse. In two relapses during the subsequent 7 months, hair loss did not recur, presumably because no additional atorvastatin was administered.
Atorvastatin is a synthetic HMG-CoA reductase inhibitor that is an effective lipid-lowering agent (
4
, 5
). Although usually well tolerated, some persons may experience alopecia due to atorvastatin. Our patient’s hair loss occurred within 6 weeks of her initial exposure to atorvastatin, abated when the drug was discontinued, and recurred within 2 weeks of a second exposure to the drug. The events show that hair loss was not due to prednisone, benazepril, or the nephrotic syndrome itself.At least one other patient has reported hair thinning after taking atorvastatin for a few months, although physicians doubted that it was due to the drug (
3
). The pattern of our patient’s hair loss, however, strongly suggests a relation between atorvastatin and alopecia.- Lee T.H.
By the way, doctor . . . My hair has been thinning out for the past decade or so, but since my doctor started me on Lipitor (atorvastatin) a few months ago for high cholesterol, I swear it’s been falling out much faster. My doctor discounts the possibility, but I looked in the Physicians’ desk reference (PDR) and alopecia is listed under “adverse reactions.” What do you think?.
Harv Health Lett. 2000; 25: 8
References
- Choice of lipid-regulating drugs.Med Lett Drugs Ther. 2001; 43: 43-48
- Recently, I heard on a TV show that anticholesterol drugs can cause hair loss. I’ve been taking Zocor for about 18 months now, and in the past 6 months I’ve noticed hair loss from the top and sides of my head. Is this common? Will my hair regrow once I stop taking the drug?.Harv Womens Health Watch. 1998; 5: 8
- By the way, doctor . . . My hair has been thinning out for the past decade or so, but since my doctor started me on Lipitor (atorvastatin) a few months ago for high cholesterol, I swear it’s been falling out much faster. My doctor discounts the possibility, but I looked in the Physicians’ desk reference (PDR) and alopecia is listed under “adverse reactions.” What do you think?.Harv Health Lett. 2000; 25: 8
- Atorvastatin—a new lipid-lowering drug.Med Lett Drugs Ther. 1997; 39: 29-31
- Atorvastatin.Drugs. 2001; 61: 1835-1881
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© 2002 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
