Jian Jun LiHui Hui LiuNa Qiong WuKhung Keong YeoKathryn TanJunya AkoRungroj KrittayaphongRu San TanPhilip E. AylwardSang Hong BaekJamshed DalalAlan Yean Yip FongYi Heng LiRichard C. O’BrienTien Siang Eric LimSi Ya Natalie KohDaniel J. SchererHayato TadaVernon KangJulie ButtersStephen J. NichollsKanazawa University Graduate School of Medical SciencesSouth Australian Health and Medical Research InstituteFuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeUniversity of MelbourneMonash UniversityNational Cheng Kung UniversityFaculty of Medicine, Siriraj Hospital, Mahidol UniversityThe University of AdelaideSarawak General HospitalThe University of Hong KongKitasato UniversityNational Heart Centre, SingaporeThe Catholic University of KoreaSingapore Heart FoundationKokilaben Dhirubhai Ambani Hospital2020-08-252020-08-252020-01-01Expert Opinion on Drug Metabolism and Toxicology. (2020)17447607174252552-s2.0-85089447575https://repository.li.mahidol.ac.th/handle/123456789/58366© 2020 Informa UK Limited, trading as Taylor & Francis Group. Introduction: Statins have been established as the standard of care for dyslipidemia and preventing cardiovascular diseases while posing few safety concerns. However, misconceptions about statin intolerance lead to their underuse, indicating a need to improve the understanding of the safety of this treatment. Areas covered: We searched PubMed and reviewed literatures related to statin intolerance published between February 2015 and February 2020. Important large-scale or landmark studies published before 2015 were also cited as key evidence. Expert opinion: Optimal lowering of low-density lipoprotein cholesterol with statins substantially reduces the risk of cardiovascular events. Muscle adverse events (AEs) were the most frequently reported AEs by statin users in clinical practice, but they usually occurred at a similar rate with statins and placebo in randomized controlled trials and had a spurious causal relationship with statin treatment. We proposed a rigorous definition for identifying true statin intolerance and present the criteria for defining different forms of muscle AEs and an algorithm for their management. True statin intolerance is uncommon, and every effort should be made to exclude false statin intolerance and ensure optimal use of statins. For the management of statin intolerance, statin-based approaches should be prioritized over non-statin approaches.Mahidol UniversityPharmacology, Toxicology and PharmaceuticsReviewSCOPUS10.1080/17425255.2020.1802426