NLA points out the need to use alternative drugs if statin intolerance occurs.

I was taught that the myalgia of statins was a specific myalgia.
I would tell patients the statin did not cause their myalgia.
They would go back on the statin and say the same myalgia occurred.
 This is why I used the triple therapy of low dose statin, Zetia and over the counter Enduracin.

I document my use of triple therapy from 2009 in my book The Tubby Theory from Topeka, replicated here
 Chapter 12 Use of triple therapy link

I always stated w the lowest dose of statin. Dr Dayspring taught some people had good results with low dose.  I advised simvastatin in 2010 as it was inexpensive generic.
Now Lipitor (atorvastatin), Crestor (rosuvastatin) are available in generic form.  These two statins are stronger and safer than Zocor (simvastatin).
 Zetia (ezetimibe) is also available in generic form.
Endur-acin (wax matrix form of nicotinic acid) is an over the counter preparation.


Now more than ever great drugs are available that I have used (see link above).
 Safe and inexpensive.
I would get referrals to treat statin intolerant patients.  I would start with Enduracin (Niacin)
This wax matrix nicotinic acid rarely caused a itchy flush.  Side effects not usually seen at low dose 1,000 mg.  This would be agreed to as it is a vitamin.
Then I would add Zetia. Maybe use 1/2 tablet first.
Finally if not at goal I would start lowest dose statin. Maybe give every other day or once a week.

These 3 drugs should be used first.
Slowly increase statin until side effects occur.

If still not at goal in a very high risk patient then PCSK9 should be considered.

 PCSK9 vs triple therapy link