7 replies to this topic

[sarahboxley]

I have been on Gleevec since my dx, and I have my 6 month bmb next week. Initially I started with an 800mg dose, which was reduced to 600mg after I had terrible muscle aches. Since the reduction, I have not had muscle aches at all. I play tennis weekly and I try to work out 2-3 times a week. I am sore after those activities, but I don't think I am more sore than usual.

Since starting Gleevec, my CPK has been borderline high - around 300. At a checkup 3 weeks ago, it crept up to 370. I had it rechecked this week, and it is even higher at 570. My hem/onc says that it is an unusual, but documented issue with the Gleevec. He has had an eye on it the whole time, and he does not seem overly concerned. I have a bmb in 12 days where he will recheck my CPK as well as PCR and other standard blood tests. In the meantime, he said I did not need to reduce or halt activity.

Has anyone had this complication? Did you end up taking a drug holiday, switching drugs or something different? My counts have reacted so well to the Gleevec, so I am hesitant to change anything. But I am only 32, so I need to be mindful of long term complications.

Thoughts?

[Trey]

Creatine phosphokinase (CPK) is most often a sign of muscle "damage".  This can include muscle pulls and strains (even heart attack -- not likely for you) but can also be caused by strenuous workouts.  In addition, TKI drugs can cause CPK to be elevated, maybe related to higher than normal muscle turnover.  In general this has not been shown to be harmful, but can be painful.  However, if you have regularly dark urine that could be a sign of true rapid muscle breakdown (rhabdomyolysis) which should definitely be monitored. 

I would suggest not working out for 4 days prior to your next blood test.

[Antilogical]

Are you taking any other medications or are you eating grapefruit? 

Here's my story:  Several years ago (pre-CML), I developed the rhabdomyolysis condition that Trey mentioned, when a blood pressure drug enhanced the effectiveness or the retention time of a cholesterol drug.  It was almost more painful than having the flu.  I was hospitalized for several days with a CPK level of 37,000 until the saline IV's flushed it out of my system.  Since I've been on Gleevec, they've had to reduce my BP meds to 1/3 the level I was taking before due to how it works with Gleevec.  My cpk was slightly elevated to 200 a couple of months ago, but went down to normal on a retest.

[Sneezy12]

Did they stop or change the Cholesterol drug, and which one was it? Regards, Frank

[Trey]

Statin drugs used to control cholesterol can cause rhabdomyolysis.  Those taking both TKI drugs and statins will probably ensure muscle pain due to excessive muscle turnover/breakdown (I realize your input was without TKI drugs at the time, but just adding for others to consider).

http://www.mayoclini...yolysis/AN01413

[sarahboxley]

Thanks for the info everyone!

I do not take any other medications (besides a vitamin). I did go on vacation in January where I ate grapefruit every morning for a week, but I haven't had any since then. The only other thought I had was alcohol? It's not like I drink heavily, but I definitely had a couple of drinks every night on my vacation. Since returning, I am probably having wine more frequently than before I left - probably 3x per week. Could this be the cause?

I also just added the tennis to my routine. It is once or twice a week and a rigorous clinic. I am moderately sore afterwards, but it isn't even enough to want a Tylenol or Advil.

[Antilogical]

Frank - I was taking 80mg of Zocor for cholesterol, plus verapamil for hypertension.  (Verapamil also reduces migraines - an awesome side effect.)  Turns out that verapamil is also known to enhance the effect of statins.  I was taken off of the Zocor for about 4 months, then I cycled through a series of meds till we found a combo that seems to keep me stable all around.

[Sneezy12]

80 mg. of Zocor is now considered a high dose, and rarely recommended. Regards, Frank