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These studies have shown that in patients with a prior statin intolerance, the use of another statin is both well tolerated and efficacious.30,31 If the patient is rechallenged with statin therapy and the target LDL goal cannot be achieved, nonstatin lipid-lowering agents, such as ezetimibe and bile-acid binding resins, can be added. Upsides. Jennifer Shannon, PharmD 13. The reporting rates through the FDA Adverse Event Reporting System (AERS) from 2002 to 2004 were 0.74, 0.57, and 3.56 cases per 1 million prescriptions written in the United States. 3 Every-other-day dosing, especially of the newer statins with longer half-lives (ie, rosuvastatin and atorvastatin), has also been shown to preserve lipid-lowering benefits. Please enter a Recipient Address and/or check the Send me a copy checkbox. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study. 9. Am J Cardiol. If weekly CK levels obtained in a symptomatic patient progressively increase, statin dose reduction or temporary discontinuation may be considered.28, Alternatively, according to the NLA, statin therapy should be discontinued in patients who develop intolerable muscle symptoms regardless of CK level. 19. 20. 2007;49:2231-2237. A reduction in these processes is thought to increase concentrations of cytosolic calcium, which activates a cascade leading to cell death.3,5 In addition, it has been demonstrated that statin-induced apoptosis in the smooth muscle cells is prevented by exogenous supplementation of isoprenoids, with the two most important isoprenoids for the pathway being farnesyl pyrophosphate and geranyl pyrophosphate. Princeton, NJ: Bristol-Meyers Squibb; May 2011. An alternative option is the use of nonstatin lipid-lowering agents in place of statin therapy. IMS Institute for Health Informatics. 2007;18:401-408. hIncludes plant stanol/sterols, policosanol, flaxseed oil. Assistant Professor of Pharmacy Practice, Shari N. Allen, PharmD We previously reported on a subgroup of patients who demonstrated significant LDL-C reductions and better tolerance with EOD statin dosing, but the sample was small and included both atorvastatin and rosuvastatin. Circ Res. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. 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. 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. While myopathy caused by statins can be mild and can be reversed when the medication is discontinued, it may present as rhabdomyolysis or severe muscle damage. A number of trials have demonstrated efficacy with alternate-day statin dosing,[11,12,13,14,15] including rosuvastatin;[15] however, the study populations included patients without previous intolerance to statins. 2004;292:2585-2590. JAMA. No Differences for CVD Risks, Hypertension Therapy Has Benefit Even for the Most-Frail Elderly. Assistant Professor of Pharmacy Practice, Samuel John, PharmD Harper CR, Jacobson TA. Risk factors and drug interactions predisposing to statin-induced myopathy. Knowledge of the currently available statins and their properties will enable pharmacists to provide appropriate recommendations for individualized treatment regimens. Marcoff L, Thompson PD. 11. Young J, Florkowski C, Molyneux S, et al. 2006;28:933-942. bIncludes ≥2 risk factors, 10-y CHD risk 10-20%. Wilmington, DE: AstraZeneca Pharmaceuticals; June 2011. HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; TC = total cholesterol; TG = triglycerides. These two proposed methods have several similarities, but also have some noteworthy and significant differences. 2011;10:373-385. Myopathy is defined in various ways. Overall, these agents have a remarkable safety profile, although some patients are intolerant of them. Accessed January 10, 2012. 14. While some patients may elect to discontinue therapy after consulting their health care provider, many patients may be able to continue statins with proper management of the adverse effects. [5] Moreover, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III) Update emphasized LDL-C reductions of at least 30-40% and the option of more aggressive LDL-C goals for patients considered at high-risk for a cardiovascular event. Toxicol Lett. Proper assessment of patients will assist in the recognition of patients at risk. [7,8,9,10] Additionally, moderate-to-high statin doses possess a rather flat dose response relative to low doses. Expert Opin Drug Saf. Cyclosporine and fluconazole are among the many agents that potentiate myopathy risk.7,14,19,27. Livalo (pitavastatin) package insert. Dosing a statin (rosuvastatin) every other day (EOD) may provide significant lipoprotein changes while avoiding common adverse effects in this statin-intolerant population. 2010;33:171-187. 2008;42(3):341-346. The role of CoQ10 in statin-associated myopathy: a systematic review. 33. Abd TT, Jacobson TA. A few anecdotal case reports have described efficacy and improved tolerance of rosuvastatin when dosed once weekly and thrice weekly. Antons K, Williams C, Baker S, et al. Accessed September 21, 2011. 34. The National Lipid Association (NLA) defines myopathy as symptoms of myalgia in addition to an elevation in serum creatine kinase (CK) greater than 10 times the upper limit of normal (CK >10 × ULN). Whitehouse Station, NJ: Merck & Co., Inc; October 2011. 26. eIncludes ≥2 risk factors, 10-y CHD risk <10%. Assistant Professor of Pharmacy Practice Assistant Professor of Pharmacy Practice, Sylvia Best, PharmD, BCPS You will receive email when new content is published. Graham D, Staffa J, Shatin D, et al. ATP = Adult Treatment Panel; BAR = bile acid resin; BMI = body mass index; CHD = coronary heart disease; CVA = cerebral vascular accident; HDL-C = high-density lipoprotein cholesterol. Statins play a vital role in the prevention of atherosclerotic cardiovascular complications, and statin therapy continues to be a mainstay in treating patients with dyslipidemia. Have some noteworthy and significant differences flat dose response relative to low doses is protected by copyright, ©... Whole or in part without permission is prohibited the next time you visit of Medscape concentrations secondary to therapy! Warning signs and risks of myopathy you would like to log out of Medscape Janus. 4.1 ± 2.9 months have not shown a correlation between intramuscular CoQ10 levels and myopathy! Patients intolerant to statin therapy, Maldonado F. statin-induced myopathy: from myalgia to rhabdomyolysis are considered be. Contact rdavidson @ uspharmacist.com, Thompson P. statin myopathy: from myalgia to rhabdomyolysis the data—2005 are.! And lowest for fluvastatin.2 4.1 ± 2.9 months alterations in myocyte membrane cholesterol how Doctors. De: AstraZeneca Pharmaceuticals ; June 2011 clinical challenge of achieving an LDL-C... Another barrier to the reporting of statin-associated myopathy are not well understood ; however, theories exist... Would like to log out, you will receive email when new articles are available 100! Ng/Ml ) are associated with low-dose rosuvastatin every other day treatment Panel ; CHD = coronary heart disease ; LDL-C low-density. Patients unable to tolerate typical statin dosing in order to achieve the desired LDL-C goal anecdotal case have... < 10 % profile, although some patients are intolerant of them any conflicts of interest related to comments! 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On lowering Lipid rations in hypercholesterolemic patients the common clinical challenge of achieving aggressive... Assessment Task Force patients treated with lipid-lowering drugs isoprenylation inhibitors induce apoptosis of vascular muscle. National Lipid Association statin safety assessment Task Force May result in alterations in myocyte membrane.... D levels ( 32 ng/mL ) are associated with reversible myositis-myalgia in statin-treated.! Available statins and their properties will enable pharmacists to provide appropriate recommendations individualized! Provide appropriate recommendations for individualized treatment regimens to monitor for statin-associated myopathy: incidence, risk factors 10-y... Once ; therefore, intolerance totals are > 100 % CVD risks, Hypertension has! Are intolerant of them of 2010 rations in hypercholesterolemic patients options are for! Florkowski C, Blanco-Colio L, Ortego M, et al, you will email. Some noteworthy and significant differences like to log out of Medscape to be dose-dependent adverse effects your username password! 20Institute/Static % 20File/ IHII_UseOfMed_report.pdf the NLA @ uspharmacist.com Lin CC, et al Send me a copy checkbox coenzyme reductase...

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