Statins

Key points

• Statins: HMG-CoA reductase inhibitors → ↓ cholesterol synthesis, ↑ LDL receptor expression.
• Main side effects: myalgia/myositis (check CK), deranged LFTs; rhabdomyolysis is rare.
• Interactions: grapefruit juice and P450 inhibitors ↑ levels; avoid with fibrates where possible (myopathy risk).
• Given at night (cholesterol synthesis is predominantly nocturnal).
• Monitor LFTs before treatment and within 3 months of starting; CK if muscle symptoms.

Decision points in this pathway

• Muscle symptoms on statin?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.