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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)

 Risks associated with statin-induced myopathy

 Small body frame
 Multisystem disease (chronic renal insufficiency due to diabetes)

 Perioperative periods: when there are underlying muscle disorders, a family history
of muscle disorders, renal impairment, untreated hypothyroidism, alcohol abuse
 Medications ex: fibrates, niacin, cyclosporine, antifungals, protease inhibitors for

AIDS, amiodarone, verapamil, grapefruit juice

 Management of Muscle symptoms on statin therapy

 If unexplained severe muscle symptoms or fatigue develop during statin therapy:
 Discontinue the statin
 Address possibility of rhabdomyolysis (CK, Creatinine, myoglobinuria)
 If mild to moderate muscle symptoms develop during therapy:

 Temporarily discontinue statin (for 4-8 weeks) until the symptoms are evaluated
 Evaluate the patient for conditions that increase risk of muscle symptoms
 If after 2 months without statin muscle symptoms or elevated CK levels do not

resolve completely, consider other causes of muscle symptoms
Note

 Goal of treatment with statins:

➢ ↓ LDL-C <70 mg/dL or at least a 50% reduction in LDL-C

 Evaluate genetic causes and secondary causes before starting statins

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