16
Treatment
Table 6. Statin Safety Recommendations (continued)
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
8. It is reasonable to evaluate and treat muscle symptoms,
including pain, tenderness, stiffness, cramping, weakness, or
fatigue, in statin-treated patients according to the following
management algorithm:
• To avoid unnecessary discontinuation of statins, obtain a
history of prior or current muscle symptoms to establish a
baseline before initiaton of statin therapy.
• If unexplained severe muscle symptoms or fatigue develop
during statin therapy, promptly discontinue the statin and
address the possibility of rhabdomyolysis by evaluating
CK, creatinine, and a urinalysis for myoglobinuria.
• If mild to moderate muscle symptoms develop during
statin therapy:
▶ Discontinue the statin until the symptoms can be
evaluated.
▶ Evaluate the patient for other conditions that
might increase the risk for muscle symptoms (e.g.,
hypothyroidism, reduced renal or hepatic function,
rheumatologic disorders such as polymyalgia
rheumatica, steroid myopathy, vitamin D deficiency, or
primary muscle diseases).
▶ If muscle symptoms resolve, and if no contraindication
exists, give the patient the original or a lower dose
of the same statin to establish a causal relationship
between the muscle symptoms and statin therapy.
▶ If a causal relationship exists, discontinue the original
statin. Once muscle symptoms resolve, use a low dose
of a different statin.
▶ Once a low dose of a statin is tolerated, gradually
increase the dose as tolerated.
▶ If, after 2 months without statin treatment, muscle
symptoms or elevated CK levels do not resolve
completely, consider other causes of muscle symptoms
listed above.
▶ If persistent muscle symptoms are determined to arise
from a condition unrelated to statin therapy, or if the
predisposing condition has been treated, resume statin
therapy at the original dose.
IIa B
