Transl Res. eIndicates optional goal from ATP-III Update. Updated April 2011. www.imshealth.com/ Reproduction in whole or in part without permission is prohibited. Crestor (rosuvastatin) package insert. 12. Assistant Professor of Pharmacy Practice, Sylvia Best, PharmD, BCPS Clinical studies have not yielded significant results.33, Additionally, the role of vitamin D has been somewhat controversial, as low levels are associated with both myalgia and poor muscle function. 2008;337:1159-1162. Overall, these agents have a remarkable safety profile, although some patients are intolerant of them. [5] We theorized that by using low doses of a statin (rosuvastatin) every other day (EOD), a significant LDL-C reduction may still be achieved while also avoiding the dose-dependent adverse effects. Rosuvastatin 5 and 10 mg/d: a pilot study of the effects in hypercholesterolemic adults unable to tolerate other statins and reach LDL cholesterol goals with non-statin lipid-lowering therapies. Statin use has been shown to decrease cardiovascular disease morbidity and mortality, but despite its advantages, over 40% of patients who have an indication for statin use are not receiving therapy. cIncludes ≥2 risk factors, 10-y CHD risk <10%. 2007;14:438-440. The lowest approved daily doses of statins will typically reduce LDL-C by 20-40% compared with moderate and high doses, which achieve only an additional 6% LDL-C reduction with each doubling of dose. Young J, Florkowski C, Molyneux S, et al. The precise mechanisms underlying statin-associated myopathy are not well understood; however, theories do exist. 26. an = 37. bAverage time to follow-up 4.1 ± 2.9 months. A Primer for Pharmacists (ARCHIVED), Intensive Statin Therapy Confers Increased Risk of Diabetes, Depressed Heart Failure Patients Got Little Benefit From SSRI Treatment, Generic or Brand-Name Levothyroxine? The American College of Cardiology (ACC), American Heart Association (AHA), and National Heart, Lung, and Blood Institute (NHLBI) use myopathy as a general term referring to any disease of the muscles, which is the most common definition.2 2006;97(suppl):89C-94C. All doses used demonstrated significant LDL-C reductions; … 6. an = 44. bIndicates a family history of premature CHD (CHD in male first-degree relative <55 y of age; CHD in female first-degree relative <65 y of age). To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. This website also contains material copyrighted by 3rd parties. Stein EA, Ballantyne CM, Windler E, et al. Clin Pharmacol Ther. The American College of Cardiology (ACC), American Heart Association (AHA), and National Heart, Lung, and Blood Institute (NHLBI) use myopathy as a general term referring to any disease of the muscles, which is the most common definition.2, When compared to clinical practice, the number of patients reporting statin-associated myopathy during clinical trials remains low, primarily because patients who are susceptible to, or who have an increased risk for, statin-associated adverse events are often excluded from clinical trials. Endocrinological Features of Hartsfield Syndrome in an Adult Patient With a Novel Mutation of FGFR1, The Effect of Sprint Interval Training on Body Composition of Postmenopausal Women, Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer, Advances in Allergen Immunotherapy for Asthma, Remote, Non-Physician-Led Care Cuts LDL, BP in High-Risk Patients, Statins Beneficial in Elderly, Guidelines Should Be Strengthened, AACE Issues 'Cookbook' Algorithm to Manage Dyslipidemia, First-of-Its Kind Guideline on Lipid Monitoring in Endocrine Diseases, Women With Heterozygous FH Less Likely to Receive Treatment, Amazon Launches Online Pharmacy in New Contest With Drug Retail, Pharmacotherapy Considerations in Hospitalized Patients With COVID-19 Pneumonia. 2002;128:159-168. Arora R, Liebo M, Maldonado F. Statin-induced myopathy: the two faces of Janus. Eur J Cardiovasc Prev Rehabil. Accessed January 10, 2012. hIncludes plant stanol/sterols, policosanol, flaxseed oil. Results: Myalgias (76.5%) and increased transaminase levels (19.5%) were the most common causes of prior statin intolerance, but 72.5% (37/51) of patients were able to tolerate the EOD therapy (mean dose 5.6 mg) regimen for 4 ± 2.9 (mean ± SD) months. New York, NY: Pfizer, Inc; January 2012. Additionally, randomized, controlled trials evaluating the use of CoQ10 as prevention have yielded equivocal results.3 The NLA does not endorse the use of CoQ10 as treatment.12,13 Chinese red rice yeast has been used for its LDL-lowering effects. The use of fibrates and niacin as monotherapy has been associated with myopathy. All patients who were considered to be intolerant to rosuvastatin EOD therapy (27.5%; 14/51) reexperienced the symptoms of their prior statin intolerance. This agent contains lovastatin and has been tolerated in those patients with an aversion to standard statin treatment. IHII_UseOfMed_report.pdf. James M Backes, PharmD; Carmelo V Venero, MD; Cheryl A Gibson, PhD; Janelle F Ruisinger, PharmD; Patricia A Howard, PharmD FCCP BCPS; Paul D Thompson, MD; Patrick M Moriarty, MD. If a patient develops rhabdomyolysis, defined as a CK level >10 × ULN or >10,000 IU/L with an elevation in serum creatinine or a requirement for IV hydration therapy, statin therapy should be discontinued immediately.29, Both the ACC/AHA/NHLBI and the NLA emphasize the importance of counseling patients who are beginning statin therapy to report muscle discomfort and/or weakness to a health care professional immediately, as well as the need to rule out other causes of myopathy should muscle symptoms occur while on statin therapy.28,29, For most patients, myopathy symptoms induced by statin therapy resolve relatively quickly; however, the results of the PRIMO study showed that it may take up to 2 months for resolution of symptoms.4 There is limited evidence regarding the treatment of statin-associated myopathy. 3. 2007;18:401-408. Efficacy and tolerability of fluvastatin XL 80 mg alone, ezetimibe alone, and the combination of fluvastatin XL 80 mg with ezetimibe in patients with a history of muscle-related side effects with other statins. Chatzizisis Y, Koskinas K, Misirli G, et al. 7. 2011;10:373-385. In another study involving the randomizing of participants into three groups, one taking 10 mg of atorvastatin (Lipitor) every other day, one taking 10 mg every day and the last taking 20 mg every other day over a period of six weeks, it was found that the reduction of LDL-C was lowest in patients taking 20 mg every other day, but this was complicated by the fact that those patients receiving 10 mg … Philadelphia College of Osteopathic Medicine School of Pharmacy Eighty patients with primary hypercholesterolemia were equally randomized to receive rosuvastatin 10 mg once daily or every … Curr Opin Lipidol. Accessed September 21, 2011. J Am Coll Cardiol. 14. However, statin-associated myopathy affects up to 10% of patients receiving statin therapy.6 Although considered a minor adverse effect, it may have a significant effect on patient adherence to statin therapy. Clinical perspectives of statin-induced rhabdomyolysis. Global/Content/IMS% FDA: Limit use of 80 mg simvastatin. Pharmacists should continue to counsel patients on the risk and warning signs of statin-associated myopathy, as the incidence underscores the need for pharmacists to play a direct role in the monitoring of statin therapy in the inpatient and outpatient setting. Pravachol (pravastatin) package insert. 30. 2002;33:2337-2341. Suwanee, Georgia, From 2006 to 2010, the number of dispensed prescriptions for lipid regulators, which primarily include statins, has continuously increased from 210.4 million to 255 million.1 The 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, more commonly known as statins, are the most widely used medications for decreasing low-density lipoprotein (LDL) cholesterol.