1. 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