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Clinician’s Corner: Statin Induced Myopathy Treatment and Prevention

Coenzyme Q-10 has been touted for everything from eye disease, heart disease to HIV. Most of the time we are using it for people who complain about muscle pain while on a statin for cholesterol management.  Many of our patients complain about muscle aches, some of them are not even on statins.  Here are the terms used to describe muscle pain. First recommendation is to have a creatine kinase (CK) level done.

Rhabdomyolysis – is characterized by markedly elevated levels of Creatine kinase ( a liver enzyme), usually greater than ten times the upper limit of normal; usually accompanied by creatinine elevation, acute kidney failure including brown urine, and urinary myoglobin.

Many of the elevations in CK are due to statin therapy but is not usually a concern until it is over 10 times the upper limits of normal.  This is very rare, and occurs in less than 0.5% of patients.  Unfortunately, many patient’s statin therapy is discontinued due to perceived side effects of muscle pain. Hypothyroidism, acute or chronic kidney failure, and obstructive liver disease can also enhance to statin induced muscle pain.

Clinical approach to “statin induced muscle pain”

  • Pravastatin (Pravachol®) -a weakling- and rosuvastatin (Crestor®) -a powerhouse- are both available generically and are inexpensive and are least likely to cause muscle pain.
  • A lot of the elevations of CK might be due to statin drug interactions so have your Thompson Pharmacist check for drug interactions.
  • Zetia (ezetimibe) is now generic, and might allow lower doses of statin, while still lowering cholesterol.
  • Always avoid gemfibrozil (Lopid®) with statin therapy.

CoQ10 for myopathy prevention:  The link to statin therapy-

Statins inhibit CoQ10 formation many theorize low CoQ10 levels might lead to myopathy. There’s no conclusive proof that CoQ10 works for statin induced myopathy but some anecdotal reports suggest it might be helpful.

Dosage: If you want to try CoQ10, we suggest starting low and dividing doses over 100 mg. Take two to three times daily to minimize nausea and diarrhea.

Adverse effects:  Most studies have not reported serious side effects related to CoQ10 use. The most common side effects of CoQ10 include insomnia, increased liver enzymes, rashes, nausea, upper abdominal pain, dizziness, sensitivity to light, irritability, headaches, heartburn, and fatigue.

  • CoQ10 should not be used by women who are pregnant or breastfeeding.
  • Statins may lower the levels of CoQ10 in the blood. However, it is unclear what type of health effect this may have on an individual.
  • CoQ10 may make warfarin, an anticoagulant (blood thinner), less effective.

If you are having muscle pain with your cholesterol drug, don’t just sop taking it!  Be sure to consult with your Thompson Pharmacist and your physician.  With both working together, your heart will be healthier, with a lower cholesterol.  You Thompson Pharmacist can help guide your physician to cost effective therapy.