Five FAQs for Statin Prescribers: Managing Side Effects

Statins are one of the most commonly prescribed drugs in the U.S. and are beneficial in patients with dyslipidemias for both primary and secondary prevention of coronary heart disease. Although generally well tolerated, as with all drugs, statins can have adverse effects. One of the most commonly reported adverse effects from statin therapy includes myalgia, or muscle pain. Muscle complaints can be common even among patients who are not on statin therapy, so it’s important for healthcare providers to determine if there is a causal relationship before considering statin discontinuation. Below are some frequently asked questions about managing statin side effects.

  1. What are the most common adverse side effects of statin therapy?
  • Myalgia
  • Increased hepatic transaminase
  • Headache
  • Gastrointestinal side effects
  • Increased creatine phosphokinase
  1. What are some conditions that can predispose patients to adverse side effects of statin therapy?
  • Patients older than 75 years old
  • Asian ancestry
  • Impaired renal or hepatic function
  • Concurrent use of a drug or drug class that is independently considered a risk factor for myopathy
  1. What should you do if mild to moderate muscle symptoms occur during statin therapy?
  • Discontinue the statin until the symptoms can be evaluated.
  • Evaluate the patient for other conditions that may increase the risk of muscle symptoms.
  • If muscle symptoms resolve and if no contraindication/causal relationship exists, continue with statin therapy.
  • If a causal relationship exists, discontinue the original statin.
  • Once muscle symptoms resolve, use a low dose of a different statin.
  1. How should patients on statin therapy be monitored?
  • Lipid panel – Obtain baseline panel then check 4-12 weeks after initiation or dose adjustment AND every 3-12 months thereafter as clinically indicated.
  • Hepatic transaminase – Obtain baseline measure and measure hepatic function if symptoms suggest hepatotoxicity thereafter.
  • CPK – Obtain baseline measure and consider measuring in any patient with symptoms suggestive of myopathy.
  1. What are contraindications to statin therapy?
  • Pregnancy or breastfeeding
  • Active liver disease
  • Allergic reaction to active ingredients
  • Unexplained persistent elevations of serum transaminases