statin-induced myopathy / myalgia

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chrsjav

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Hi,

I'm an entering M1, and I have a quick question regarding statin-induced myopathy (normal CK levels). Are there any other interventions besides CoQ10 supplementation and reduction or cessation of statin therapy?

As an aside, the patient in question told me that 22mg of the New Chapter CoQ10 preparation is more effective at reducing his leg pain than 200 mg of any other brand.

Thanks in advance.

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Recent RCT published in JACC showed no benefit for CoQ 10. Probably best study to date. Probably a harmless placebo though so let people keep telling you it works.

Things to try:
Switching lipophilic vs phobic statin
Trying Pravachol
Trying high potency statin infrequently (i.e. three times week)
Making sure no other drug interactions, grapefruit juice, etc
Retry another random statin
Tell them to live with some pain and monitor CKs
Treat their OA
Give in and start Zetia
 
Recent RCT published in JACC showed no benefit for CoQ 10. Probably best study to date. Probably a harmless placebo though so let people keep telling you it works.

Things to try:
Switching lipophilic vs phobic statin
Trying Pravachol
Trying high potency statin infrequently (i.e. three times week)
Making sure no other drug interactions, grapefruit juice, etc
Retry another random statin
Tell them to live with some pain and monitor CKs
Treat their OA
Give in and start Zetia

Great advice, thank you. Could you post a link to the JACC paper? I did a quick search but didn't find it.

As far as CoQ10--you're right, it has never been proven to prevent or reduce statin myalgia, but it's still too early to say. Clearly, CoQ10 should not be routinely recommended. However, this particular patient relates the onset of symptoms to discontinuing CoQ10. As you said, there are no known risks to CoQ10 supplementation, so I'm not going to recommend that he stops something that works for him.
 
JACC 2007; 49; 2231-37.
sorry, just largest review to date
 
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