By now, nearly everybody has heard about the Food and Drug Administration warning of muscle damage associated with high doses of simvastatin.
This advisory is not a major surprise to most clinicians. I have found myalgias to be a fairly frequent issue with simvastatin, even at the 40-mg dose. It is remarkable how much musculoskeletal symptoms can be relieved with statin holidays. I’ve even had patients suffer exercise-related myalgias associated with the cholesterol medication.
Questions arise as to how to weight these risks and how to manage high cholesterol in patients with significant cardiovascular risk when they have suffered statin-induced myalgias. I have been using every other day rosuvastatin at the 10- or 20-mg dose in selected patients and have achieved good control of LDL without the associated muscle side effects. There is evidence that supports such dosing (Ann Pharmacother.2008;42:341-6).
Granted, there are no studies looking at the anti-inflammatory effectiveness of every other day statins, but this strategy has resulted in my practice meeting LDL goals and achieving patient satisfaction and symptom reduction. If you try this approach, however, anticipate a few quizzical phone calls from pharmacies when a patient first submits a prescription for q.o.d. or three-times-a-week therapy!