Managing statin-related muscle problems

A 60-year-old man with coronary artery disease comes for a follow-up visit. At his previous visit 2 months ago, you reduced his atorvastatin dose to 10 mg from 40 mg daily as he complained of severe myalgia and his creatine kinase level was twice the upper limit of normal. No other cause was found for his muscle problem. After taking the reduced dose for 3 weeks he stopped atorvastatin completely as troublesome myalgia persisted. He has not taken a statin in the last 5 weeks and his myalgia has improved. Now he is reluctant to be restarted on a statin.

What are your options to manage this patient?

Journal of the Ceylon College of Physicians, 2014,45,51-56