Intended for healthcare professionals

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Editorials

Statins evidence: when answers also raise questions

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4963 (Published 14 September 2016) Cite this as: BMJ 2016;354:i4963

Rapid Response:

Prescribing statins

When prescribing a statin is being considered, patients should be advised that statins are a wonder drug in reducing cholesterol & cardiovascular disease. The secondary causes of hypercholesteroleamia should be excluded and a baseline serum creatine kinase measured and if raised then repeat after 3 days rest. Then take a history of muscle disorders and pain and fatigability. It is usual to start on either simvastatin or atorvastatin, which are both metabolised by the same pathway. Preferably start on the lowest dose & titrate up.

If a patient complains of muscle discomfort, immediately monitor serum creatine kinase and if raised repeat after 3 days rest. If normal or marginally raised, then the patient should be reassured. If raised then consider changing to a lower dose or another statin but not simvastatin or atorvastatin. Start the new statin on the lowest dose and titrate up. If the patient does not tolerate the new statin, then try another statin. The order to be tried is usually, rosuvastatin, pravastatin & fluvastatin.

However if serum creatine kinase exceeds 5 x upper limit normal (ULN), then discontinue the statin1. Monitor serum creatine kinase and exclude other causes of raised creatine kinase.

References
1.BNF 68, 2.12 Lipid lowering drugs, statin side effects. p 171

Competing interests: No competing interests

26 September 2016
Jeffrey L Barron
Consultant Chemical Pathologist
Brighton & Sussex University Hospitals
Brighton