This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Management of statin induced myopathy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • undertake diagnostic workup as described
  • if the workup suggests a neurologic, rheumatolic or metabolic aetiology, a referral to a specialist is indicated
  • if myopathy with multiple statin challenges then specialist advice should be sought
  • use of a statin holiday
    • a 6-week 'statin holiday' may be used to see if symptoms of myopathy resolve
      • some give these patient supplements of 600 mg daily of a bioavailable source of coenzyme Q10 and fish oil during this statin holiday (1)
      • if symptoms persist or if resolution is unclear at 6 weeks, extend the holiday for an additional 6 weeks, except in patients with recent unstable coronary disease:
        • for these patients, unless there is evidence of rhabdomyolysis, we believe that the benefits of continued statin therapy exceed the risks (1)
  • once the myopathy symptoms have abated or are controlled, a rechallenge of statin therapy is in order for those whose risk profile suggests greater benefit from statin therapy (note a statin rechallenge is not appropriate if there has been evidence of statin-induced rhabdomyolysis)
    • long acting fluvastatin or a statin with less cytochrome P 450 dependence, such as pravastatin, are often the first line if previous statin-induced myopathy
    • if myopathy has recurred with multiple statin rechallenges or whose lipid-lowering goal requires a more potent therapy, rosuvastatin in alternate-day or once- or twice-a-week schedules is efficacious and well tolerated in many patients
      • however, although such alternate-day therapies may produce excellent reductions in cholesterol levels, these regimens have not been proven to reduce cardiovascular end points
    • alternative therapies may require seeking specialist advice but include:
      • ezetimibe
      • bile sequestrants
      • fibrates
      • nicotinic acid
      • PCSK9 inhibitors

Reference:


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.