Moderate
Atorvastatin × Rosuvastatin
HMG-CoA reductase inhibitors (statins)×HMG-CoA reductase inhibitors (statins)
Mechanism
Dual statin therapy – doubling the same pharmacological class with additive myopathy risk and no therapeutic benefit.
Symptoms
Pain and weakness in large muscle groups (thighs, shoulders, calves), dark urine, elevated creatine kinase. Symptoms usually appear 2–6 weeks after starting the combination.
Management
The combination is not prescribed. Use one statin titrated to LDL target. If LDL is not at goal on the maximum statin dose, add ezetimibe or a PCSK9 inhibitor, not a second statin.