1. A 85 years old gentleman, who is a diabetic but is otherwise healthy presented for an annual physical examination and the lipid profile checked at that time showed

Total Cholesterol – 183 mg/dL
HDL Cholesterol – 40mg/dL
Triglycerides – 100 mg/dL

His PCP started him on Atorvastatin 40 mg daily. After 2 weeks of taking the medicine he developed pain in his calf and thigh on the right side. The patient read that statins can cause myopathy and went back to his PCP for a review. At this point:

1. Start him on non steroidal anti inflammatory agents
2. Lower the dose of statins, check CPK levels
3. Admit him in the ICU for aggressive hydration
4. Discontinue statins, check serum CPK level and reassure the patient.

Answer: The correct answer is to discontinue statins, check a CPK level and reassure the patient. Usually statin induced muscle injury starts 2 – 4 weeks after starting therapy with statins. It has been shown that muscle pain starts even before serious myopathy occurs. Therefore in the initial stages the CPK might be normal. Most cases of myopathy with statins resolve spontaneously with cessation of statins. CPK should still be checked to see if severe damage is occuring in which case admission/hydration as treatment for rhabdomyolysis would be done.