What is the management approach for patients with statin-induced myopathy?

From the Guidelines

Statin-induced myopathy should be managed by first discontinuing the statin medication and monitoring creatine kinase (CK) levels until symptoms resolve, as recommended by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1. The management approach for patients with statin-induced myopathy involves several key steps:

• Discontinuing the statin medication until symptoms resolve
• Monitoring CK levels to assess the severity of muscle damage
• Evaluating the patient for other conditions that may be contributing to muscle symptoms, such as hypothyroidism or vitamin D deficiency
• Considering alternative lipid-lowering therapies, such as ezetimibe or PCSK9 inhibitors, for patients who cannot tolerate statins
• Rechallenging with a lower dose or different statin once symptoms have resolved, if necessary Some important considerations in managing statin-induced myopathy include:
• The risk of severe myopathy or rhabdomyolysis, which requires immediate medical attention
• The potential for statin-associated muscle symptoms to be exacerbated by certain medications or comorbidities
• The importance of regular monitoring of CK levels and liver function tests in patients taking statins
• The need for a comprehensive evaluation of musculoskeletal symptoms before initiating statin therapy, as recommended by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1. It is also important to note that coenzyme Q10 supplementation is not recommended for routine use in patients treated with statins or for the treatment of statin-associated muscle symptoms, as stated in the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1.

From the FDA Drug Label

Myopathy and Rhabdomyolysis: Risk factors include age 65 years or greater, uncontrolled hypothyroidism, renal impairment, concomitant use with certain other drugs, and higher rosuvastatin tablets dosage. Discontinue rosuvastatin tablets if markedly elevated CK levels occur or myopathy is diagnosed or suspected Temporarily discontinue rosuvastatin tablets in patients experiencing an acute or serious condition at high risk of developing renal failure secondary to rhabdomyolysis. Inform patients of the risk of myopathy and rhabdomyolysis when starting or increasing rosuvastatin tablets dosage Instruct patients to promptly report unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever.

The management approach for patients with statin-induced myopathy includes:

• Discontinuation of the statin if markedly elevated CK levels occur or myopathy is diagnosed or suspected 2
• Temporary discontinuation in patients experiencing an acute or serious condition at high risk of developing renal failure secondary to rhabdomyolysis 2
• Patient education on the risk of myopathy and rhabdomyolysis, and instruction to promptly report unexplained muscle pain, tenderness, or weakness 2
• Monitoring of CK levels and liver enzymes, and consideration of alternative treatments if myopathy or rhabdomyolysis occurs 3
• Discontinuation of the statin if immune-mediated necrotizing myopathy (IMNM) is suspected 3

From the Research

Management Approach for Statin-Induced Myopathy

The management of statin-induced myopathy involves several strategies to minimize the risk of myopathy and manage its symptoms. Some of the key approaches include:

• Discontinuation of statin use: This is the most effective treatment for statin-induced myopathy, as it eliminates the cause of the myopathy 4.
• Statin switching: Switching to a different statin or a non-statin lipid-lowering agent may be effective in managing statin-induced myopathy 5.
• Dose reduction: Using the lowest effective dose of statin can help minimize the risk of myopathy 4.
• Avoiding polytherapy: Avoiding the use of multiple medications that can increase the risk of myopathy, such as drugs that interact with statins, can help minimize the risk of myopathy 4.

Risk Factors for Statin-Induced Myopathy

Several risk factors can increase the likelihood of developing statin-induced myopathy, including:

• Age: Older adults are at higher risk of developing statin-induced myopathy 6, 5.
• Sex: Women are more likely to develop statin-induced myopathy than men 6.
• Genetics: Certain genetic factors can increase the risk of statin-induced myopathy 5.
• Co-morbidities: Certain medical conditions, such as kidney or liver disease, can increase the risk of statin-induced myopathy 5.
• Vitamin D deficiency: Low levels of vitamin D have been linked to an increased risk of statin-induced myopathy, and supplementation with vitamin D may improve tolerance to statins 7.

Diagnosis and Treatment of Statin-Induced Myopathy

Diagnosing statin-induced myopathy typically involves a combination of clinical evaluation, laboratory tests, and imaging studies. Treatment usually involves discontinuing the statin and managing symptoms, such as muscle pain and weakness. In some cases, switching to a different statin or non-statin lipid-lowering agent may be effective 5, 8.