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Statins : adverse effects and intolerance management NICE

A table highlighting the key messages by NICE when dealing with statin-related adverse effects


Advice and Monitoring for Adverse EffectsRecommendations
Advise people on statins• Potential interactions with other drugs/foods/supplements
• Consult pharmacist/prescriber for advice
• Restart statin if stopped due to interactions or intercurrent illnesses
Before offering a statin• Ask about muscle symptoms history
• if associated or not with previous lipid-lowering therapy
• if they have ➡️ measure creatine kinase levels
Muscle symptoms and creatine kinase levels• >5 times upper limit measure CK after 7 days if CK levels are still 5 times ULN ➡️ Do not start statin ❌
• Raised but <5 times: ✅Start at a lower dose
Risk of muscle adverse effects• Low risk of muscle pain, tenderness, weakness is small
• Extremely low risk of severe effects ( rhabdomyolysis )
Unexplained muscle symptoms• Advise seeking medical advice
• Measure creatine kinase if this happens
Muscle symptoms with normal creatine kinase• Reassure unlikely due to statin, explore other causes
• If they report muscle pain, tenderness or weakness and CK is < 5 times ULN -reassure that symptoms are unlikely due to statins
Asymptomatic individuals on statins• No...

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