Table 2.

Risk factors for statin-induced myopathy8,21,33,34

Patient-related factors	Drug interactionrelated factors
Advanced age (especially >80 years old)	Gemfibrozil (contraindicated with statins)
Female	Red yeast rice (contraindicated with statins)
Low BMI	Niacin (limit to 1 g/day)
Asian ethnicity	Macrolide antibiotics
Presence of renal disease	Azole antifungals
Presence of hepatic disease	Protease inhibitors
Untreated hypothyroidism	Large quantities of grapefruit juice
Low vitamin D levels	Nefazodone (discontinued antidepressant)
Hypertension	Cyclosporine (avoid simvastatin, lovastatin and atorvastatin)
Diabetes mellitus	Verapamil/diltiazem
Biliary tract obstruction	Warfarin
Personal or family history of SaMAEs	Digoxin
Family history of myopathy	Amiodarone
Genetic polymorphisms of the CYP isozymes	Ticagrelor (avoid simvastatin)
Inflammatory or inherited metabolic muscle disease (e.g. McArdle’s disease or carnitine palmitoyltransferase II deficiency)	Colchicine
Strenuous exercise	Fusidic acid
Surgery with severe metabolic demands	Antipsychotics
	Alcohol abuse (independently predisposes to myopathy)
	Drug abuse (e.g. cocaine, amphetamines or heroin)
	High statin dose

BMI = body mass index; SaMAEs = statin-associated muscle adverse events; CYP = cytochrome P450.