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Table 5. Assessment and Management of Muscle Symptoms
During Statin Therapy
Î Evaluate and treat muscle symptoms, including pain, tenderness,
stiffness, cramping, weakness, or fatigue, in statin-treated patients
according to the following management algorithm (IIa-B)
A. To avoid unnecessary discontinuation of statins, obtain a history of prior or
current muscle symptoms to establish a baseline before initiating statin therapy.
B. 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.
C. 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.
D. 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.
CK, creatine kinase, a test of muscle injury
