Statin-related myotoxicity

Endocrinol Nutr. 2016 May;63(5):239-49. doi: 10.1016/j.endonu.2016.01.001. Epub 2016 Mar 19.
[Article in English, Spanish]


Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statin-related myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice.

Keywords: Drug-related side effects; Efectos secundarios a fármacos; Estatinas; HMG-CoA reductase inhibitors; Inhibidores de la HMG-CoA reductasa; Intolerancia a estatinas; Miopatía; Miotoxicidad; Myopathy; Myotoxicity; Statin intolerance; Statins.

Publication types

  • Review

MeSH terms

  • Clinical Trials as Topic
  • Comorbidity
  • Creatine Kinase / blood
  • Cytochrome P-450 CYP3A / physiology
  • Dietary Supplements
  • Disease Management
  • Disease Susceptibility
  • Drug Interactions
  • Drug Substitution
  • Exercise
  • Ezetimibe / therapeutic use
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / pharmacology
  • Incidence
  • Male
  • Meta-Analysis as Topic
  • Muscular Diseases / chemically induced*
  • Muscular Diseases / epidemiology
  • Muscular Diseases / genetics
  • Muscular Diseases / physiopathology
  • Rhabdomyolysis / chemically induced
  • Rhabdomyolysis / epidemiology
  • Rhabdomyolysis / physiopathology
  • Risk Factors


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Cytochrome P-450 CYP3A
  • CYP3A4 protein, human
  • Creatine Kinase
  • Ezetimibe