Consider an annual non-fasting blood test for non-HDL cholesterol to inform the discussion. [2014] 1.4.30 Discuss with people who are stable on a low- or middle-intensity statin the likely benefits and potential risks of changing to a high-intensity statin when they have a medication review and agree with the person whether a change is needed. [2014] For information about implementing this recommendation, see the implementation: getting started section. Advice and monitoring for adverse effects 1.4.31 Advise people who are being treated with a statin: that other drugs, some foods (for example, grapefruit juice) and some supplements may interfere with statins and to always consult the patient information leaflet, a pharmacist or prescriber for advice when starting other drugs or thinking about taking supplements. [2014] 1.4.32 Remind the person to restart the statin if they stopped taking it because of drug interactions or to treat intercurrent illnesses. [2014] 1.4.33 Before offering a statin, ask the person if they have had persistent generalised unexplained muscle pain, whether associated or not with previous lipid-lowering therapy. If they have, measure creatine kinase levels. If creatine kinase levels are more than 5 times the upper limit of normal, re-measure creatine kinase after 7 days. If creatine kinase levels are still 5 times the upper limit of normal, do not start statin treatment. If creatine kinase levels are raised but less than 5 times the upper limit of normal, start statin treatment at a lower dose. [2014] 1.4.34 Advise people who are being treated with a statin to seek medical advice if they develop muscle symptoms (pain, tenderness or weakness). If this occurs, measure creatine kinase. 