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Holiday from use of statins

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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For patients who cannot tolerate statin therapy, alternatives include a 'statin holiday' followed by a rechallenge with a different statin

Use of a statin holiday

  • if there is 'statin intolerance' then one management option suggested is to prescribe a 6-week 'statin holiday' and see if symptoms resolve
    • the process of atherosclerotic plaque formation is one that occurs over months and years rather than weeks and therefore it is reasonable (in most cases) to suspend statin therapy for a 6 week period - the suspension of statin therapy is controversial if unstable coronary disease although Fernandez et al (1) suggest statin therapy can be halted for a maximum of 6 weeks in this situation
    • if statins are also for the management of high triglycerides then this makes the undertaking of a 'statin holiday' problematic because of the more immediate risk of pancreatitis associated with raised triglycerides - if there is any doubt about the suitability of the use of a 'statin holiday' then consult expert advice

  • in patients whose evaluation suggests statin myopathy, a statin holiday indicates stopping all lipid-lowering therapy for 6 weeks and seeing if symptoms resolve
    • grip and hip strength increases can be assessed by dynamometry

  • some give these patient supplements of 600 mg daily of a bioavailable source of coenzyme Q10 and fish oil during this statin holiday (1)
    • data supporting the use of these supplements are mixed but the risks are minimal

  • if symptoms do not resolve after a 6-week course of the coenzyme Q10 and fish oil
    • it has been suggested (1) that if symptoms persist or if resolution is unclear at 6 weeks
      • extend the holiday for an additional 6 weeks, except in patients with recent unstable coronary disease: for these patients, unless there is evidence of rhabdomyolysis, we believe that the benefits of continued statin therapy exceed the risks

  • if the initial evaluation is consistent with statin myopathy and the neuromuscular symptoms (myalgias and weakness) do not respond within a few months of statin withdrawal
    • specialist review is indicated to evaluate for an underlying muscular or neurologic disorder that has become symptomatic during statin therapy but whose existence is independent of the statin therapy
      • in some cases, the preexisting disorder may become symptomatic because of the statin therapy and remain symptomatic despite discontinuation of the statin therapy
  • if 'statin holiday' has led to symptomatic resolution then alternative options for management include:
    • careful rechallenge with a different statin, use of same statin but at lower dose, intermittent use of a long acting statin such as rosuvastatin

Reference:


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