Strategies to preserve the use of statins in patients with previous muscular adverse effects

• Published in: American journal of health-system pharmacy Vol. 69; no. 4; pp. 291 - 300
• Main Authors: Reinhart, Kurt M, Woods, J Andrew
• Format: Journal Article
• Language: English
• Published: England American Society of Health-System Pharmacists 15.02.2012; Oxford University Press
• Subjects: Alfacalcidol; Calcifediol; Care and treatment; Complications and side effects; Coronary Disease - drug therapy; Coronary Disease - prevention & control; Development and progression; Drug Administration Schedule; Health aspects; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Micronutrients - therapeutic use; Muscular Diseases - chemically induced; Muscular Diseases - pathology; Myalgia; Practice Guidelines as Topic; Risk factors; Statins; Ubiquinone - therapeutic use; Vitamin D; Vitamin D - therapeutic use; Vitamins - therapeutic use; United States
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp100700

The published evidence on strategies for avoiding the discontinuation of statin therapy due to muscular adverse effects is reviewed. Statin medications are a cornerstone of the prevention and treatment of coronary heart disease, but about 20% of treated patients develop myalgia or other muscle-related adverse effects that can lead to the discontinuation of statin use. As there are no consensus guidelines or firm practice recommendations on continuing or reinitiating statin therapy in patients who experience statin-related muscular adverse effects, a literature search was conducted to evaluate a variety of strategies that have been studied. The search results indicated that the most widely used strategies are (1) alternative statin dosing, (2) co-enzyme Q10 supplementation, (3) vitamin D supplementation, (4) conversion to red yeast rice (RYR) therapy, and (5) conversion to a different statin. While positive results in some patients have been reported with all of the strategies reviewed, the available evidence is insufficient to support the routine use of any of the strategies in clinical practice. In particular, the use of RYR, which contains a naturally occurring statin, is not recommended due to limited and inconsistent study results and uncertainty about the contents of commercially available RYR products. In patients intolerant to statin therapy due to myalgia or other muscular adverse effects, strategies such as alternative statin dosing schedules, coenzyme Q10 or vitamin D supplementation, and conversion to RYR or an alternative statin may allow some patients to continue to receive the benefits of lipid-lowering therapy.