The primary care management of myalgia in patients who are taking statins

Working Party—Kassianos, Armitage, Gill, Morrell, Reckless, Viljoen

This guideline was developed by a multidisciplinary expert panel: Kassianos G et al with the support of a grant from AstraZeneca. See bottom of page for full disclaimer. 

Definition of myalgia and associated terms

  • Myalgia: muscle pain, tenderness, or weakness without creatine kinase elevation* that is generalised and symmetrical and present for 3 or more days
  • Myositis: muscle symptoms with increased creatine kinase levels (typically >5 × ULN and <20 × ULN)*
  • Rhabdomyolysis: muscle symptoms with marked creatine kinase levels that are typically >20 times ULN with creatinine elevation and renal failure (usually with brown urine and urinary myoglobin)

* This depends on the baseline level for a particular patient and a normal range based on the general population may not be appropriate for an individual patient. Higher levels are seen in some populations (e.g. those of African or Caribbean origin), in highly muscular individuals or after strenuous exercise, and a decline is common with increasing age

The elevated level of creatine kinase should return to normal within a few days of statin withdrawal

  • It is clear that statins can rarely cause myositis and even more rarely, rhabdomyolysis. It is much less clear that statins are responsible for myalgia with normal (or even mildly raised) CK levels
  • It is important to remember that muscle pain presenting in the majority of patients taking statins is unlikely to be due to the statin, and in the case of myalgia, where significant CK elevation has been excluded, careful consideration of the options should precede statin withdrawal

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