Is CK elevated in statin myopathy?
The most severe adverse effect of statins is myotoxicity, in the form of myopathy, myalgia, myositis or rhabdomyolysis. Clinical trials commonly define statin toxicity as myalgia or muscle weakness with creatine kinase (CK) levels greater than 10 times the normal upper limit.
When do you check CK after statins?
Statin treatment should be discontinued immediately if an elevated CK level is found (i.e. CK >10 x upper limit of normal6), or where myopathy is suspected or diagnosed. If there is a moderate rise in the CK level (i.e. 3-10 x upper limit of normal) then monitor CK levels weekly and seek specialist advice.
When do you hold statins for elevated CK?
If a patient’s CK is elevated, should the statin be stopped? The CK should be repeated in 6 to 12 weeks or if the patient develops symptoms. If the patient has symptoms, hold the statin until other causes are ruled out.
Can you take a fibrate with a statin?
In contrast, fenofibrate does not use this metabolic pathway and therefore has a minimal effect on the pharmacokinetics of statins, making it safe to use in combination with a statin.
Why does statin cause myopathy?
Recently, a new etiopathogenetic mechanism has been proposed, in which the immune system also plays a role. This is the case of immune-mediated necrotizing myopathy and antibodies against HMGCR, the enzyme that is usually upregulated by statins.
Which statin has highest risk of myopathy?
Certain statins are associated with a higher incidence of myopathy. Bruckert et al used pravastatin as a reference and demonstrated that atorvastatin and simvastatin were associated with higher incidences of myopathy, whereas fluvastatin XL was associated with a lower incidence.
Do statins raise CK?
Statins can magnify exercise-induced marked elevation of the CK.
Are CPK and CK the same?
Creatine kinase (CK), also known as creatine phosphokinase (CPK) or phosphocreatine kinase, is an enzyme (EC 2.7. 3.2) expressed by various tissues and cell types. This CK enzyme reaction is reversible and thus ATP can be generated from PCr and ADP.
Why do statins cause myopathy?
Any factor that increases the serum concentration of a statin has the potential to increase the risk of myopathy. Therefore, factors that affect the pharma- cokinetics of statins, leading to increased concentra- tions of the drugs in blood or tissue, may predispose to myopathy.
What are the symptoms of statin myopathy?
Statins and muscle pain
- muscle pain.
- muscle fatigue.
- muscle weakness.
When do you add fibrate to statins?
Practical pearl: As a way to further reduce CV events in patients with metabolic syndrome or diabetes, consider adding a fibrate to those on statin therapy that still have both high TG levels (>200mg/dL) and low HDL (<40 mg/dL in males, <50 mg/ dL in females).
Which Fibrate is best?
Fenofibrate has less potential than other fibrates to interact with statins, and is therefore the best fibrate to use in statin-fibrate combination therapy.
When to discontinue statin treatment for myopathy?
Statin treatment should be discontinued immediately if an elevated CK level is found (i.e. CK >10 x upper limit of normal), or where myopathy is suspected or diagnosed. If there is a moderate rise in the CK level (i.e. 3-10 x upper limit of normal) then monitor CK levels weekly and seek specialist advice.
What should the CK level be for myopathy?
CK >10 x upper limit of normal), or where myopathy is suspected or diagnosed. If there is a moderate rise in the CK level (i.e. 3-10 x upper limit of normal) then monitor CK levels weekly and seek specialist advice.
When to check CK levels with a statin?
Patients who are prescribed statins need to be informed of the importance of promptly reporting unexplained muscle pain, tenderness or weakness, particularly if accompanied by malaise or fever. Measure CK levels in patients who present with such symptoms.
What is the risk of myopathy with simvastatin alone?
The risk of myopathy or rhabdomyolysis with simvastatin alone is dose related; the incidence, determined from clinical trials, is approximately 0.03% at 20mg, 0.08% at 40mg and 0.4% at 80mg daily. This risk is increased with concomitant fibrates, as they alone can cause myopathy.