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*
If either SLCO1B1 or CYP2C9 genotypes are unavailable, scroll down to “Instructions for Unavailable Genotypes”.
Instructions for Unavailable Genotypes
If for SLCO1B1 either Assay Failure, Unable to Genotype, or Unknown Phenotype are resulted or SLCO1B1 was not genotyped, but CYP2C9 is available, utilize the SLCO1B1 Normal Function page and select the appropriate CYP2C9 phenotype for the recommendation. These recommendations may be affected by the patient’s unavailable SLCO1B1 genotype; consider testing or repeat testing of SLCO1B1 as appropriate.
If for CYP2C9 either Assay Failure, Unable to Genotype, or Unknown Phenotype are resulted or CYP2C9 was not genotyped, but SLCO1B1 is available, select the appropriate page above based on SLCO1B1 phenotype and then utilize the recommendation for CYP2C9 Normal Metabolizer phenotype. These recommendations may be affected by the patient’s unavailable CYP2C9 genotype; consider testing or repeat testing of CYP2C9 as appropriate.
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 determined 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.