The evidence on managing patients intolerant of cholesterol-lowering medications is not based on any large-scale randomized trials. However here are options:
1. If is clear a patient would benefit from a statin (e.g. documented CAD, MI etc.) I encourage them to try every possible statin before declaring them intolerant.
2. Sometimes patients have stopped the statin for a few weeks, then restarted (either same dose, or ½ dose) without further problems
3. If the problem was with a statin alone, I start ezetimibe (ezetrol ®) 10 mg OD first, which then allows me to use a lower dose of a statin later to achieve target.
4. Giving less frequent doses of statins with longer half-lives (e.g. atorvastatin, rosuvastatin) is better than not being on one at all. For example, rosuvastatin given every 2 days, or even 2 times/week has been shown to lower LDL-cholesterol.
5. I’ve not tried this as evidence is conflicting but the use of Coenzyme Q-10 has been shown in some small studies to help.
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