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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can Lipitor cause severe joints pain in the knee, shoulders and hip?

Answered by
Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3132 Questions

Posted on Tue, 21 Aug 2018 in Medicines and Side Effects
Question: I am a male 6’ 170lbs 56years old never had cholesterol or heart problems after I had a stroke brought on by high blood pressure October 2017
I was placed on a precautionary dose of Lipitor 40mgs daily and i am experiencing severe joint pain in my knee, shoulders and hip. Would a lower does (say 20 mgs of this precautionary medication help the pain go away? Since it appears the cardiologist is going to keep me on this indefinitely
Answered by Dr. Bonnie Berger-Durnbaugh 31 minutes later
Brief Answer:

Get CK checked then re-evaluate; Crestor in low intermittent dose possible.

Detailed Answer:

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

I am sorry for this trouble and unfortunately musculoskeletal problems from statins are not uncommon.

It's possible that a lower dose may give less intense symptoms but they may still continue to some extent.

It's important when a person on a statin is experiencing musculoskeletal pain to check muscle and liver enzymes which should include a CK level and creatinine level.

If the CK is greater than 10 x ULN, the statin must be stopped, rhabdomyolysis needs to be treated, and then the need for continued statins has to be reevaluated.

If the CK is less than 10 x ULN but there is pain, then evaluation of other factors such as Vitamin D level and hypothyroidism (and other meds) should be looked into. It's best to get these levels drawn at the same tie as the CK level to save time.

If there is no problem with these other things, then switching to another statin such as Crestor 5-10 mg every other day is indicated.

If the symptoms continue, then switching to a non-statin such as niacin (a B vitamin), bile acid sequestrants, or ezetimibe is the next step.

But it is important to see where things are at with blood tests so you know what you are dealing.

Here is a portion of an article that might help for you to see - it's from:
Diabetes Care. 2013 Aug; 36(Suppl 2): S325–S330.
Published online 2013 Jul 17. doi: 10.2337/dcS13-2038
Intolerance to Statins: Mechanisms and Management XXXXXXX Bitzur, MD, Hofit Cohen, MD, Yehuda Kamari, MD, and Dror Harats, MD

When a statin-treated patient develops muscle-related symptoms, CK level should be measured to rule out rhabdomyolysis (CK levels >10 times the upper limit of normal values or elevation of serum creatinine levels), which mandates immediate stopping of the statin and prompt hydration. In the vast majority of cases, CK levels will be normal or only mildly elevated

The presence of contributing factors, such as strenuous exercise and consumption of grapefruit juice, should be assessed. Depending on the statin used, the use of medications that inhibit CYP3A4 (such as azole antifungals, macrolide antibiotic, fibrates, and calcium channel blockers), or CYP2C9 (such as amiodarone) should be ruled out.

Thyroid function should be assessed, as subclinical hypothyroidism may contribute to statin-associated myopathy. Vitamin D deficiency should also be ruled out and treated if found, as it may cause myalgia. Several small studies have found that correction of vitamin D deficiency may enable patients with a history of statin-associated myopathy to tolerate statins (35).

The importance of lifestyle measures, including diet and exercise, should be stressed. Adding phytosterols to a heart-healthy diet may produce ~10% decrease in LDL cholesterol (36). Supplements such as CoQ10, vitamin E, and magnesium are often tried, but as previously mentioned, there are very little data to support their use.

Statin-based approaches.

Switching statins may be efficacious. In one small study, 43% of 37 patients who received another statin after an episode of statin-associated myopathy tolerated other statins without recurrent symptoms (37). Considering the results of the PRIMO study, the use of statins associated with a lower risk of myopathy, such as fluvastatin or pravastatin, may be considered (4), although these statins may not be potent enough if a large reduction of LDL cholesterol is needed to reach target values. In one study, 80 mg fluvastatin XL daily (as a slow-release preparation) was tolerated in 97% of patients with prior statin intolerance owing to muscle-related symptoms, and LDL cholesterol was reduced by 32.8% (38).

Another approach evaluated in several studies involves the use of long-acting statins, mainly rosuvastatin [Cretor], in low doses or at a reduced frequency (1–3 times a week). For example, in a retrospective analysis of 51 patients with a statin, alternate-day rosuvastatin at a mean dose of 5.6 mg was tolerated in 72.5% of patients, with an LDL cholesterol reduction of 34.5% (39).

Nonstatin medications.
When no statin is tolerated or the maximal tolerable dose of statins fails to reduce LDL cholesterol to target levels, nonstatin therapies should be used.

The most commonly used drug is ezetimibe. Ezetimibe as monotherapy or added to 80 mg fluvastatin XL daily in patients with prior statin intolerance was well tolerated and produced a 15% reduction in LDL cholesterol (38). It should be noted that currently there are no studies that demonstrate ezetimibe's efficacy in reducing cardiovascular morbidity and mortality.

Another option to reduce cholesterol absorption is the use of bile acid sequestrants (BAS), which were proven to reduce cardiovascular events in the Lipid Research Clinics Study Coronary Primary Prevention Trial (LRC-CPPT) (40). BAS can be combined with ezetimibe to produce a greater reduction in LDL cholesterol (41). The use of BAS is associated with a high rate of gastrointestinal side effects, leading to discontinuation rates as high as 40–60%. Colesevelam has a better side effects profile and may lead to better patient compliance (42).

Niacin at daily doses from 500 to 2,000 mg lowers LDL cholesterol by ~20%. Given as monotherapy in the Coronary Drug Project study, niacin reduced cardiovascular morbidity and mortality (43). Niacin can also be used in combination with BAS and ezetimibe in statin-intolerant patients requiring a large reduction in LDL cholesterol (42). The use of niacin is limited by its side effects, mainly flushing, which can lead to the drug being discontinued in up to 25% of patients (44).

Hope I have answered your query.

Take care

Dr. Bonnie Berger-Durnbaugh, General & Family Physician
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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