Brief Answer:
Questions so that I can advise

Detailed Answer:
Hello and welcome,

To be able to answer whether you creatinine kinase level is a cause for concern, I'll need to know a few more things:

1. What was the actual result? The amount of elevation can make a difference.
2. What was the reason this was tested? The context of what is going on makes a difference too. Are you on any medications and do you have any ongoing health problems?
3. What other tests were done and were they all normal?
4. Has there been an upward trend in past CK tests? (If you don't know the answer to this one, that's ok)

I'll write back after I hear from you - thanks.

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Brief Answer:
Thoughts on this

Detailed Answer:
Yes, that is significantly high. While it could be partly elevated because of muscular exertion (muscle breakdown), if you have been on statins before and during when this test was taken, then I definitely would talk with your doctor about a trial of getting off of them and retesting the CK.

I don't know how many or how significant the cardiovascular risk factors are that necessitated being on a statin, so I am hesitant to tell you outright to stop taking it. But with a CK of 428, it definitely needs to be looked into, modifications need to be made (such as possibly getting off of the statin) and then retest.

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Brief Answer:
Thoughts on this

Detailed Answer:
I see that you are off the bp medicine. Are you still taking the statin? And is there a history of cardivascular events (stroke, heart attack) in your family and if so, at what age? Also, do you have diabetes or pre diabetes or smoke cigarettes?

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Brief Answer:
Thoughts on this

Detailed Answer:
If you were taking the statin every 2nd day and this is your CK after that, then I think it would be prudent to get you off the statin. Exercise can bring up the CK, but usually when it is as high as yours is, it is often due to the statin. I advise talking with your doctor, and going off for a period of several weeks and then retesting.

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Brief Answer:
Your welcome!

Detailed Answer:
That would be the best thing to do.

For your reference, I'm including part of an article from UpToDate.com which summarizes most recent research and guidelines on specific topics.

Best regards,
Bonnie Berger-Durnbaugh, MD
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Based on clinical experience, in the absence of clinical symptoms, a creatine kinase (CK) level >10 times the upper limit of normal that is felt to be due to a statin is an indication for discontinuing the medication. Patients should drink large quantities of fluids to facilitate renal excretion of myoglobin.
[Note that yours is not >10 times the upper limit which is approximately 198, so while your situation isn't an emergency, it still should be addressed. - BBD]

If a patient requires a statin and experiences muscle toxicity (other than rhabdomyolysis), once symptoms have resolved and the CK has returned to baseline off statin therapy, we suggest the following approach:

●Assess for drug interactions, including those related to addition of a new medication or a change in administration of a long-term medication, and modify therapy to minimize any drug interactions and then restart statin therapy (potentially switching to pravastatin, fluvastatin, rosuvastatin, or pitavastatin, which have fewer drug interactions) with careful monitoring.

●Assess for vitamin D deficiency and hypothyroidism and correct if present, and then resume statin therapy with careful monitoring.

●If no drug interactions were present, the patient had appropriate levels of vitamin D and thyroid hormone, and the patient was on a statin other than pravastatin, fluvastatin, or pitavastatin, switch therapy to pravastatin or fluvastatin with careful monitoring.

●If switching statin therapy to an agent with a different pharmacokinetic profile is unsuccessful, initiate alternate-day (or less frequent) dosing with careful monitoring.

Patients with a history of statin-induced rhabdomyolysis should generally not be treated with another statin (including pravastatin and fluvastatin), because of the risk of recurrence. In some cases, it may be reasonable to retry statin therapy after the resolution of an acute reversible event that contributed to muscle toxicity (eg, undetected hypothyroidism, acute renal failure, biliary obstruction, use of other medications that increase statin levels).

Vitamin D — If a patient with statin myopathy is known to be vitamin D deficient, it is reasonable to assess vitamin D status and, in patients with vitamin D deficiency, administer vitamin D replacement therapy and then rechallenge with statin therapy. Low vitamin D levels are associated with myopathy in statin-treated patients.

Some studies, but not all, have suggested that low vitamin D levels may be associated with statin myopathy. Case reports, case series, and some small, inadequately controlled studies have reported improvement in symptoms of statin myopathy in patients supplemented with vitamin D. Even if patients with vitamin D deficiency have a higher rate of statin myopathy, vitamin D may be a marker for other risk factors for myopathy (such as other nutritional deficiencies) rather than itself the cause of myopathy.

Switching statins — As discussed above, pravastatin, fluvastatin, and pitavastatin appear to have much less intrinsic muscle toxicity than other statins. Thus, in patients who have developed statin myopathy (other than rhabdomyolysis) on a statin other than pravastatin or fluvastatin, an option is to switch to one of those two medications once symptoms have resolved off statin therapy.

Switching to fluvastatin was studied in a randomized trial in 199 patients with prior statin myopathy; 17 percent of patients treated with extended-release fluvastatin monotherapy developed recurrent muscle symptoms (versus 24 percent with ezetimibe and 14 percent with combination therapy).

Alternate-day dosing — Daily dosing of statins is preferred whenever possible, since daily regimens are the ones that have been studied and proven to reduce clinical events. Clinical experience suggests that alternate-day dosing may improve the tolerability of statins in patients experiencing myalgias, and this strategy appears to have equal LDL-C lowering efficacy and can reasonably be tried in patients unable to tolerate daily statin therapy.

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