Muscle pain with taking statin Stop statin and check CK, allow CK to return to baseline No clinical rhabdo and CK < 3x normal Clinical rhabdo with CK >= 3x normal If obvious reversible cause,* correct and if high CVD risk, consider careful re-challenge or change to pravastatin Correct reversible causes* and either 1) re-challenge or 2) change to pravastatin Success *reversible causes: drug interaction, hypothyroid, acute renal failure, biliary obstruction Recurrence Success Consider trial of every other day dosing Recurrence Stop statin, consider alternate agent in high risk patients