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Post-Stroke Statin Myalgia – Management — SCE Neurology MCQ

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EasyCerebrovascular DiseasePost-Stroke Statin Myalgia – ManagementSCE Neurology

A 55-year-old man with a recent stroke is started on a statin for secondary prevention. He develops muscle aches after starting atorvastatin. His CK is normal. What is the recommended management?

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Correct answer: A — If CK is normal and symptoms are tolerable, continue the statin with monitoring — if symptoms are significant, consider switching to an alternative statin (rosuvastatin), lower dose, or alternate-day dosing; statins should NOT be permanently discontinued after stroke without strong justification

Statin-related muscle symptoms (myalgia) are common (~10–15%) but rarely indicate serious myopathy (which requires CK >10× ULN). With normal CK, the symptoms may improve with: dose reduction, switching to an alternative statin (rosuvastatin may be better tolerated), alternate-day dosing, or adding coenzyme Q10 (weak evidence). Given the critical importance of statins for secondary stroke prevention, permanent cessation should be avoided if possible. A: Permanent cessation is rarely justified after stroke. C: Increasing dose worsens myalgia. D: Fibrates are less effective for stroke prevention. E: Secondary prevention is essential.

Reference: NICE CG181 Lipid Modification; RCP Stroke Guidelines