SLCO1B1 and Atorvastatin

To compare statin-associated musculoskeletal symptoms (SAMS) by statin intensities with doses for SLCO1B1 decreased and poor function to guide alternative statin selection, click here. For recommendations for patients on existing statin therapy, see footnote below list*

SLCO1B1 Increased Function

Clinical Implication

  • Increased SLCO1B1 transporter function.
  • Normal myopathy risk expected.

Therapeutic Recommendation

  • Initiate standard dosing.

SLCO1B1 Normal Function

Clinical Implication

  • Normal SLCO1B1 transporter function.
  • Normal myopathy risk expected.

Therapeutic Recommendation

  • Initiate standard dosing.

SLCO1B1 Decreased Function

Clinical Implication

  • Decreased SLCO1B1 transporter function.
  • Moderate risk of statin-induced myopathy with 40 mg.
  • High risk of statin-induced myopathy with 80 mg.

Therapeutic Recommendation

  • Initiate ≤ 40 mg, if a dose > 40 mg is needed, consider combination therapy.

SLCO1B1 Poor Function

Clinical Implication

  • No SLCO1B1 transporter function.
  • High risk of statin-induced myopathy with 40-80 mg.

Therapeutic Recommendation

  • Initiate ≤ 20mg, if a dose > 20mg is needed, consider rosuvastatin (≤ 20mg) or combination therapy.

Unable to Genotype or Assay Failure

  • The analysis failed to yield an informative result and thus no genotype is reported.

Unknown Phenotype

  • This individual is carrying at least one allele with uncertain/unknown function and the predicted phenotype cannot be dtermined at this time. 

*Recommendations for patients on existing statin therapy

For patients who are currently taking a statin with moderate risk of statin-induced myopathy, if the statin has been continued at a stable dose for 4 weeks without symptoms suggestive of statin-induced myopathy it may be reasonable to continue the current statin therapy, while if dosing has continued for less than 4 weeks clinicians can consider changing the statin or dose to a regimen with lower risk that meets the appropriate guideline recommended intensity.

For patients who are currently taking a statin with high risk of statin-induced myopathy, if the statin has been continued at a stable dose for at least 1 year without symptoms suggestive of statin-induced myopathy it may be reasonable to continue the current statin therapy, while if dosing has continued for less than one year clinicians can consider changing the statin or dose to regimen with lower risk that meets the appropriate guideline recommended intensity.

See statins with moderate and high risk of statin-induced myopathy.

Reference

  • Cooper-DeHoff RM et al. Clin Pharmacol Ther. 2022 May;111(5):1007-1021. PMID: 35152405.

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