From the Guidelines
The patient should temporarily discontinue Crestor and be reassessed in 2-4 weeks to discuss alternative lipid-lowering strategies, as the benefits of statin therapy outweigh the risks of muscle pain, and most patients can be successfully treated with at least one statin 1. This approach is supported by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol, which recommends a management strategy of statin discontinuation until symptoms improve, followed by rechallenge with a reduced dose, alternative agent, or alternative dosing regimen while monitoring for recurrent symptoms 1. Key considerations in managing this patient's muscle pain include:
- Ruling out rhabdomyolysis with creatine kinase levels if the pain is severe or accompanied by dark urine 1
- Evaluating for potential drug interactions, vitamin D deficiency, or hypothyroidism, which can exacerbate statin-related muscle symptoms
- Considering alternative statins like pravastatin or fluvastatin, which have lower rates of muscle symptoms
- Using an alternate-day dosing regimen or non-statin medications like ezetimibe if necessary It is essential to weigh the benefits of statin therapy against the risks of muscle pain, as the majority of patients can be successfully treated with at least one statin, and the benefits of statin therapy outweigh the risks of new-onset diabetes mellitus 1.
From the Research
Patient Profile
- Age: 74 years
- Complaint: Muscle pain
- Medication: Crestor (rosuvastatin)
Relevant Studies
- A study published in 2022 2 found that the most common reason for discontinuing statin therapy was patient experience of adverse events, with musculoskeletal and connective tissue disorders being the most common.
- Another study from 2014 3 reported that statins can cause neuropsychiatric adverse events, including behavioral alterations, cognitive and memory impairments, sleep disturbance, and sexual dysfunction.
- A 2020 study 4 found that statins can cause dose-dependent borderline elevations of liver function tests over time, but these elevations are clinically and statistically insignificant.
- A review of rosuvastatin/ezetimibe published in 2020 5 found that the combination is effective in reducing low-density lipoprotein cholesterol and total cholesterol in adults with hypercholesterolemia, with a similar safety profile to rosuvastatin monotherapy.
- Guidelines for statin treatment in older adults, reviewed in 2020 6, provide little specific guidance for physicians considering statin discontinuation in older adults with declining health status and short life expectancy.
Potential Causes of Muscle Pain
- Musculoskeletal and connective tissue disorders, a common adverse event associated with statin therapy 2
- Neuropsychiatric adverse events, including behavioral alterations and cognitive impairments, which may be related to muscle pain 3
- Liver function test elevations, although these are typically clinically insignificant 4