Strategies to preserve the use of statins in patients with previous muscular adverse effects.
OBJECTIVE
The published evidence on strategies for avoiding the discontinuation of statin therapy due to muscular adverse effects is reviewed.


CONCLUSIONS
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.


CONCLUSIONS
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.
School of Pharmacy, Wingate University, Asheville, NC 28174, USA.
Kurt M
KM
Reinhart
J Andrew
JA
Woods
D003327:Coronary Disease / Q000188:drug therapy* / Q000517:prevention & control; D004334:Drug Administration Schedule; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018977:Micronutrients / Q000627:therapeutic use; D009135:Muscular Diseases / Q000139:chemically induced* / Q000473:pathology; D017410:Practice Guidelines as Topic; D014451:Ubiquinone / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018977:Micronutrients; D014815:Vitamins; D014451:Ubiquinone; D014807:Vitamin D