Not All Statins are Equal – Environmental and Genetic Myotoxicity Risk Factors

Dose-dependent statin-related myotoxicity (SRM) is a rare adverse effect of statin treatment.Differences in the pharmacokinetics and interactions with environmental and genetic factors constitute important risk factors for the development of SRM.We present the case of an 82-year-old female patient with severe simvastatin-related myotoxicity and several risk factors of SRM, namely a pharmacokinetic interaction with verapamil, a pharmacogenetic interaction with a SL-CO1B1*1/*5 variant, high age, female gender and impaired renal function.A comprehensive evaluation of distinct pharmacokinetic and pharmacogenetic properties of different statins and a pharmacogenetic panel test guided the diagnosis and options for further clinical management.Inspired by this and other similar cases, we developed a pocket card as practical companion for statin prescribing in clinical practice and provide it as an addition to this report.