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The risk of severe myopathy increased with pitavastatin dosages exceeding 4 mg daily.
Adjustment for toxicity are described as follows.
Severe muscle symptoms or fatigue: Promptly discontinue use; evaluate CPK, creatinine, and urinalysis for myoglobinuria.
Mild to moderate muscle symptoms: Discontinue use until symptom can be evaluated; evaluate patients for conditions that may increase the risk for muscle symptoms (e.g hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia, rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases). Upon resolution, resume the original dose or lower dose of pitavastatin. If muscle symptoms recur, discontinue pitavastatin use.
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