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• W2890908876 abstract "To the Editor: We read with interest the recent publication concerning vismodegib-induced muscle spasms by Girard et al.1Girard E. Lacour A. Abi Rached H. et al.Occurrence of vismodegib-induced cramps (muscular spasms) in the treatment of basal cell carcinoma: a prospective study in 30 patients.J Am Acad Dermatol. 2018; 78: 1213-1216Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Although we agree that adequate hydration and muscle stretching can be of use in these patients, we have found that L-carnitine supplementation is effective at reducing muscle cramps in patients taking vismodegib.2Dinehart M.S. McMurray S. Dinehart S.M. Lebwohl M. L-carnitine reduces muscle cramps in patients taking vismodegib.Skin. 2018; 2: 90-95Crossref Google Scholar, 3Cannon J.G.D. Tran D.C. Li S. Chang A.S. Levocarnitine for vismodegib-associated muscle spasms: a pilot randomized, double-blind, placebo-controlled, investigator-initiated trial.J Eur Acad Dermatol Venereol. 2018; 32: e298-e299Crossref PubMed Scopus (4) Google Scholar Research suggests that these muscle cramps are related to the paradoxical activation of the noncanonical smoothened–Ca2+–AMP-activated protein kinase axis and inhibition of the canonical smoothened signaling pathway by vismodegib.4Lacouture M.E. Dreno B. Ascierto P.A. et al.Characterization and management of hedgehog pathway inhibitor-related adverse events in patients with advanced basal cell carcinoma.Oncologist. 2016; 21: 1218-1229Crossref PubMed Scopus (103) Google Scholar These changes result in an influx of Ca2+ into muscle cells and consequent muscle contraction. L-carnitine produces energy in cells by transporting long-chain fatty acids from the cytoplasm into mitochondria. The resulting ATP can be used to pump out the excess calcium, thus stabilizing the sarcolemma. L-carnitine is a naturally occurring amino acid that has already been found to be an effective treatment for muscle cramps that occur in patients with liver cirrhosis.5Nakaniahi H. Kurosaki M. Tsuchiya K. et al.L-carnitine reduces muscle cramps in patient with cirrhosis.Clin Gastroenterol Hepatol. 2015; 13: 1540-1543Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar It appears to be most effective when started before vismodegib treatment in doses of 1-2 g/d and can be obtained without a prescription because it is sold as a dietary supplement.2Dinehart M.S. McMurray S. Dinehart S.M. Lebwohl M. L-carnitine reduces muscle cramps in patients taking vismodegib.Skin. 2018; 2: 90-95Crossref Google Scholar Adverse events from L-carnitine are unusual. Although there is still much to be learned about adverse reactions in patients taking hedgehog inhibitors, we encourage others to use L-carnitine to help reduce the muscle cramps that occur in these patients. Occurrence of vismodegib-induced cramps (muscular spasms) in the treatment of basal cell carcinoma: A prospective study in 30 patientsJournal of the American Academy of DermatologyVol. 78Issue 6PreviewTo the Editor: Vismodegib is a hedgehog pathway inhibitor approved for treating locally advanced and metastatic basal cell carcinoma. Cramps (muscular spasms) are among vismodegib's major adverse effects (40%-80% of patients).1,2 In the pivotal study of Sekulic et al, 72.1% of treatment discontinuation occured within the first year of follow-up.2 A recent study shows that stretching muscles before going to sleep reduces both the frequency and severity of nighttime cramps.3 Our objective was to characterize cramps and discuss an appropriate treatment. Full-Text PDF" @default.
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• W2890908876 date "2023-01-01" @default.
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• W2890908876 title "Reply to: “Comment on ‘Occurrence of vismodegib-induced cramps (muscular spasms) in the treatment of basal cell carcinoma: A prospective study in 30 patients'”" @default.
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• W2890908876 doi "https://doi.org/10.1016/j.jaad.2018.07.069" @default.
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