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Cholesterol: Don’t Give Up on Statins Written by Seth M. Adams, Pharm.D. It is well established that statins are considered the first-line pharmacologic therapy for dyslipidemia. Statins have been proven to reduce atherosclerotic cardiovascular disease risk; however, nearly a third of patients started on statins report muscle aches or weakness. This all too often leads to giving up on the statin, which could potentially be a life-saving medication. Instead of discontinuing statins therapy, here are some alternatives you can try. • Rechallenge. Patients should try an alternative statin. Studies show about 90% of patients who stopped statin therapy due to side effects were able to tolerate after trying again. In fact, 40% of patients tolerated rechallenging with the same statin. Additionally, fluvastatin and pravastatin may have a lower risk of causing myopathy than the other statins. • Check for interactions. Atorvastatin, lovastatin, and simvastatin all can have increased risk of causing statin-induced myopathy with concurrent use with other medications that are CYP3A4 inhibitors. If CYP3A4 inhibitors cannot be avoided, try a statin less dependent on CYP3A4 metabolism, such as fluvastatin, pitavastatin, pravastatin, or rosuvastatin. • Try switching to fenofibrate. Patients on gemfibrozil can try fenofibrate, which has a lower risk of statin-induced myopathy than gemfibrozil. • Try alternative dosing strategies, such as every-other-day statin dosing. References 1. PL Detail-Document, Characteristics of the Various Statins. Pharmacist’s Letter/Prescriber’s Letter. May 2012. 2. PL Detail-Document, Lipid Treatment FAQs. Pharmacist’s Letter/Prescriber’s Letter. July 2014. 3. PL Detail-Document, Statin-Associated Muscle Symptoms. Pharmacist’s Letter/Prescriber’s Letter. June 2012. 4. PL Detail-Document, Statin Muscle Symptoms: Managing Statin Intolerance. Pharmacist’s Letter/Prescriber’s Letter. October 2015. 5. Rodriguez-Gutierrez R, Shah ND, Montori VM. Predicting the Overuse of PCSK-9 Inhibitors. JAMA. 2015;314(18): 1909-1910. Don’t give up on statins until you have tried some of these tips. It could be life saving. L uxury L iving P A C I F I C 98 TM