Features of statin intolerance:
(1) new onset or worsening of a problem after starting statin therapy
(2) problem recognized as statin-related (myopathy, hepatitis, etc)
(3) problem resolves after statin dose is decreased or stopped
Riak factors:
(1) age > 75 years
(2) history of statin intolerance
(3) history of a muscle disorder (myopathy)
(4) unexplained elevation of serum ALT more than 3 times the upper limit of normal (ULN), i.e. hepatitis
(5) other significant comorbid conditions, especially renal insufficiency
(6) concurrent medications affecting statin metabolism
(7) a strong family history of statin intolerance or myopathy (Table 8, 2b)
A patient without these risk factors can be started on high intensity statin therapy if indications for therapy are present. A patient with risk factors should be considered for moderate intensity therapy and monitored more closely for complications.
A patient on a high dose of statins may be at increased risk for adverse drug effects.
