statinintolerant

Statin intolerance, or the condition of being statin-intolerant, refers to the inability to continue statin therapy due to adverse effects that limit dose or necessitate discontinuation. The term often centers on statin-associated muscle symptoms (SAMS), but it can also include liver enzyme elevations or other adverse effects attributed to statins. Distinguishing true statin intolerance from nonadherence, symptom misattribution, or intolerance due to other illnesses is an important part of assessment.

Symptoms commonly attributed to statins include muscle pain, weakness, or cramps, sometimes with normal or elevated creatine kinase levels. Severe myopathy and rhabdomyolysis are rare. Liver injury is uncommon but liver function is typically monitored during statin use. Diagnosis is largely clinical and by exclusion of other causes; a supervised rechallenge with a different statin or a lower dose can help determine whether symptoms are truly statin-related. Contributing factors such as hypothyroidism, vitamin D deficiency, kidney disease, and drug interactions (for example with certain fibrates, macrolide antibiotics, or cytochrome P450 inhibitors) should be addressed.

Management aims to balance cardiovascular risk reduction with tolerability. Strategies include reinitiating therapy with a different statin, adjusting the dose, or using intermittent dosing. If statin therapy remains intolerable, non-statin lipid-lowering options are available, including ezetimibe, bempedoic acid, PCSK9 inhibitors (alirocumab, evolocumab), inclisiran, and bile acid sequestrants, alongside lifestyle measures. In some cases intolerance is transient and may improve with time or alternative formulations. Patients with suspected statin intolerance are often managed in collaboration with a lipid specialist.