Low dose therapy may provide an effective and tolerable alternative for patients experiencing statin intolerance, with research suggesting alternate day dosing of rosuvastatin and atorvastatin being as efficacious at lowering LDL-C levels as daily dosing, with significant cost savings as an added bonus.
Safety
American Heart Association10 released an in-depth Scientific Statement regarding statin safety and tolerability that offers an in-depth examination of evidence related to their safety and tolerability, emphasizing that most evidence does not support a misperception that they can lead to frequent side effects; and recommended improved clinician counseling about muscle symptoms’ relative rarity as means for strengthening patient adherence with guideline-driven therapy regimens.
When muscles symptoms do arise, they tend to be mild and rarely recur. Clinicians should always listen and support a patient’s concerns while conducting a comprehensive physical exam in order to detect myopathy/rhabdomyolysis as well as rule out alternative causes like hypothyroidism and vitamin D deficiency as potential causes for muscle discomfort. If no other causes can be identified, clinicians may try lowering the dose or switching to another agent that does not cause such reactions (for instance rosuvastatin or atorvastatin). This strategy may be particularly beneficial in elderly patients given their increased risk of medication complications due to age-related decreased renal glomerular filtration rates and multiple comorbidities. Furthermore, it could prove useful for HIV on ART who should avoid pitavastatin interactions, or prior intracranial hemorrhage victims due to potential thromboembolic events.
