Version July 2025
ALT: alanine aminotransferase; CK: creatinine kinase; CVD: cardiovascular disease; FLP: fasting lipid profile; LDL-C: low density lipoprotein cholesterol.
* Refer to UpToDate drug information topics for information on dosing of individual statin medications in children. The initial choice of agent is generally based on potential drug interactions, experience with the drug in children, price, and patient preference. In the authors' practice, we most commonly use atorvastatin or rosuvastatin. Statin medications are usually given at bedtime, because most LDL-C synthesis occurs during nighttime hours.
¶ Adverse side effects from statin therapy are uncommon. Toxicity can include elevated liver enzymes (≥3 times the upper limit of normal) and myopathy (ie, elevated CK [≥10 times the upper limit of normal] or suggestive symptoms such as weakness, asthenia, and/or muscle cramps). These are more likely at higher doses and in patients taking other medications. We check ALT at approximately 4 weeks after starting therapy to assess for hepatotoxicity. Further testing of liver function and/or CK in asymptomatic patients is generally not necessary. However, testing should be performed if the patient has concerning symptoms (eg, muscle aches or weakness) or other comorbidities (eg, liver disease).
Δ Targeted values of LDL-C depend on the presence of associated CVD risk factors. For children at high risk, the goal is LDL-C <100 mg/dL (2.6 mmol/L); for children in the moderate- and at risk categories, the goal is LDL-C <130 mg/dL (3.36 mmol/L).
◊ Care must be taken if a fibrate is added to a statin because this may increase the risk of side effects, particularly muscle toxicity. Referral to a pediatric lipid specialist is advised.
