Managing statin-induced muscle toxicity in a lipid clinic

Abstract

We show that for the majority of patients with statin-induced muscle toxicity, statin therapy can be safely and effectively continued. In cases of asymptomatic CK levels <3-5 upper limit of normal (ULN), statin treatment should not be interrupted. When CK levels >3-5 ULN or when various symptomatic muscle adverse reactions are present, statins rechallenge, after a recovery period, should be individualized either by a low dose of a potent statin or by a less potent statin. An additional lipid medication is advised if the target levels are not achieved.

Phenotype Standardization for Statin-Induced Myotoxicity

“…20,34,35 With the increasing use of electronic medical records, it may be possible to use CK elevations to identify patients with statin myotoxicity. However, because the use of CK as a screening test for muscle injury is not recommended, the identification of an isolated CK elevation in an electronic (or paper-based) record may indicate suspicion of the clinician of muscle toxicity, even if symptoms are variably recorded.…”

Successful reintroduction of statin therapy after statin-associated rhabdomyolysis

“…In all 3 of these reported cases, the patient was also successfully restarted on statin therapy with good effect. 7 Zhang et al 9 found that 92% of patients who discontinued statins due to AEs were successfully rechallenged. This supports our experience that patients with a serious muscle AE may be restarted on a statin without recurrence.…”

“…6 A clinic reported on 54 cases of patients with serious muscle adverse effects, including 3 classified as rhabdomyolysis, that were successfully rechallenged with statins. 7 Here we present a case of a patient successfully tolerating a statin for 4 y after previously developing rhabdomyolysis while taking a statin.…”

Statin myopathy: the fly in the ointment for the prevention of cardiovascular disease in the 21st century?

“…Retrospective audits of real-world tertiary clinics report that the majority of affected patients are able to tolerate reintroduction of the statin [10,45,46]. Intermittent dosing may be useful, especially in subjects who are intolerant to multiple statins [46].…”

“…Utilizing alternative cholesterol-lowering therapies that replace or spare the use of statins has also been examined using therapies such as Ezetimibe, bile acid resins, Niacin, plant sterols and red yeast rice [47,[49][50][51]. Ezetimibe, bile acid sequestrates and niacin are less efficacious than statins in lowering low density lipoprotein (LDL)-C, and the last two have their own unacceptable side effects, specifically nausea, bloating, constipation with resins and flushing with niacin [52,53].…”