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Expert opinion: the therapeutic challenges faced by statin intolerance.
Expert Opin Pharmacother. 2016 Aug; 17(11):1497-507.EO

Abstract

INTRODUCTION

Statin intolerance is largely defined by muscle related symptoms, leading to intolerability and cessation. The nocebo effect coupled with the challenges of diagnosing statin myopathy undermines drug adherence that is critical for achieving the benefits of lipid-lowering and cardiovascular risk reduction. A temporal relationship should be made between the initiation of therapy and development of symptoms to aid in diagnosis. The mainstay of treatment is statin cessation or statin dose reduction and evaluation of alternative causes for muscle related symptoms. Most symptoms usually resolve within 2 weeks of discontinuing therapy. The patient can be re-challenged with the same statin at a lower dose or an alternative statin. Non-statin lipid lowering therapies offer an alternative to patients who cannot tolerate statins.

AREAS COVERED

We discuss current guideline-focused management of patients with statin intolerance.

EXPERT OPINION

When initiating statin therapy, attention to risk factors for statin intolerance is strongly recommended. Most patients will tolerate some degree of statin therapy; thus statin re-challenge is advisable. If alternative dosing regimens are not tolerated, non-statin medications are acceptable alternatives. To limit errors in the diagnosis of statin intolerance, improvements in clinician-patient communication about the side effects and benefits of statins should be attempted.

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  • Publisher Full Text

    • Authors+Show Affiliations

    Patel J
    a Department of Cardiology , Johns Hopkins Ciccarone Center for the Prevention of Heart Disease , Baltimore , MD , USA. b Department of Internal Medicine , VCU Medical Center , Richmond , VA , USA.
    Martin SS
    a Department of Cardiology , Johns Hopkins Ciccarone Center for the Prevention of Heart Disease , Baltimore , MD , USA.
    Banach M
    c Department of Hypertension , Medical University of Lodz , Lodz , Poland.

    MeSH

    Cardiovascular DiseasesDose-Response Relationship, DrugHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMuscular DiseasesRisk Factors

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    27254275

    Citation

    Patel, Jaideep, et al. "Expert Opinion: the Therapeutic Challenges Faced By Statin Intolerance." Expert Opinion On Pharmacotherapy, vol. 17, no. 11, 2016, pp. 1497-507.
    Patel J, Martin SS, Banach M. Expert opinion: the therapeutic challenges faced by statin intolerance. Expert Opin Pharmacother. 2016;17(11):1497-507.
    Patel, J., Martin, S. S., & Banach, M. (2016). Expert opinion: the therapeutic challenges faced by statin intolerance. Expert Opinion On Pharmacotherapy, 17(11), 1497-507. https://doi.org/10.1080/14656566.2016.1197202
    Patel J, Martin SS, Banach M. Expert Opinion: the Therapeutic Challenges Faced By Statin Intolerance. Expert Opin Pharmacother. 2016;17(11):1497-507. PubMed PMID: 27254275.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Expert opinion: the therapeutic challenges faced by statin intolerance. AU - Patel,Jaideep, AU - Martin,Seth S, AU - Banach,Maciej, Y1 - 2016/06/13/ PY - 2016/6/3/entrez PY - 2016/6/3/pubmed PY - 2017/2/22/medline KW - Intolerance KW - cardiovascular KW - myopathy KW - prevention KW - statin SP - 1497 EP - 507 JF - Expert opinion on pharmacotherapy JO - Expert Opin Pharmacother VL - 17 IS - 11 N2 - INTRODUCTION: Statin intolerance is largely defined by muscle related symptoms, leading to intolerability and cessation. The nocebo effect coupled with the challenges of diagnosing statin myopathy undermines drug adherence that is critical for achieving the benefits of lipid-lowering and cardiovascular risk reduction. A temporal relationship should be made between the initiation of therapy and development of symptoms to aid in diagnosis. The mainstay of treatment is statin cessation or statin dose reduction and evaluation of alternative causes for muscle related symptoms. Most symptoms usually resolve within 2 weeks of discontinuing therapy. The patient can be re-challenged with the same statin at a lower dose or an alternative statin. Non-statin lipid lowering therapies offer an alternative to patients who cannot tolerate statins. AREAS COVERED: We discuss current guideline-focused management of patients with statin intolerance. EXPERT OPINION: When initiating statin therapy, attention to risk factors for statin intolerance is strongly recommended. Most patients will tolerate some degree of statin therapy; thus statin re-challenge is advisable. If alternative dosing regimens are not tolerated, non-statin medications are acceptable alternatives. To limit errors in the diagnosis of statin intolerance, improvements in clinician-patient communication about the side effects and benefits of statins should be attempted. SN - 1744-7666 UR - https://www.unboundmedicine.com/medline/citation/27254275/Expert_opinion:_the_therapeutic_challenges_faced_by_statin_intolerance_ L2 - http://www.tandfonline.com/doi/full/10.1080/14656566.2016.1197202 DB - PRIME DP - Unbound Medicine ER -