Statin Myalgia Management — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyStatin Myalgia ManagementRACP Adult Medicine

A 65-year-old woman on atorvastatin 80 mg develops persistent myalgia with a CK level of 800 U/L (3× ULN). She has a history of ACS and her LDL-C on atorvastatin was 1.6 mmol/L (above the <1.4 mmol/L target). What is the appropriate statin management?

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Correct answer: D — Switch to rosuvastatin at lower dose with rechallenge

For statin-associated muscle symptoms with CK 3–10× ULN, the statin should be withheld until symptoms and CK normalise, then rechallenged with a different statin at lower dose. Rosuvastatin or pitavastatin at lower doses, or alternate-day statin dosing, may be tolerated. Complete statin cessation is inappropriate in a patient with ACS given the strong cardiovascular benefit. If all statins are intolerable, ezetimibe ± PCSK9 inhibitor should be used to achieve the LDL-C target. The 2025 Australian ACS guideline emphasises reaching <1.4 mmol/L regardless of statin tolerance.

Reference: NHF/CSANZ – 2025 – ACS Guideline; AMH – 2025 – Statins