Statins : adverse effects and intolerance management NICE

Advice and Monitoring for Adverse Effects	Recommendations
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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