Raised CK (creatine kinase)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected rhabdomyolysis (severe pain, dark urine, very high CK): emergency
- Refer to the emergency department the same day: renal function, serum potassium, ECG.
- Stop any ongoing statin.
Incidentally found raised CK, no or few symptoms
In 7 days, without physical exertion in the meantime
- Creatine kinase (CK) (repeat)
- TSH
- Serum creatinine with eGFR
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)if needednon-French guidelineCK remaining raised without other explanation: coeliac disease is among the non-neuromuscular causes to rule out [5].
- Serum β-hCGif needednon-French guidelineWoman of childbearing potential: pregnancy is among the non-neuromuscular causes of raised CK [5].
- Serum electrolytesif needednon-French guidelineThe 2024 European EAN recommendation lists hypokalaemia, hyponatraemia and parathyroid disorders among the non-neuromuscular causes to consider once hyperCKaemia is confirmed [6]. The text names these causes without specifying the tests.
- Serum calciumif needednon-French guidelineThe 2024 European EAN recommendation lists hypokalaemia, hyponatraemia and parathyroid disorders among the non-neuromuscular causes to consider once hyperCKaemia is confirmed [6]. The text names these causes without specifying the tests.
Do not order
- CK in coronary artery disease in the community: test not indicated and not reimbursable in France for this indication (except for monitoring statin treatment) [7].
Muscle symptoms on a statin
Laboratory tests
- Creatine kinase (CK)
- TSH
- Serum creatinine with eGFRif needednon-French guidelineRenal failure (stages 3 to 5) is a risk factor for muscle symptoms on statins [2].
Do not order
Sources (14)
- Kyriakides T, Angelini C, Schaefer J, et al. EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia. Eur J Neurol. 2010;17(6):767-773.
- Stroes ES, Thompson PD, Corsini A, et al. Statin-associated muscle symptoms: impact on statin therapy. European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J. 2015;36(17):1012-1022.
- Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care. 2016;20(1):135.
- Kruijt N, Laforet P, Vissing J, Bhai S, Stemmerik MG, Kleefeld F, Voermans NC, et al. 276th ENMC International Workshop: recommendations on optimal diagnostic pathway and management strategy for patients with acute rhabdomyolysis worldwide. Neuromuscul Disord. 2025;50:105344.
- Moghadam-Kia S, Oddis CV, Aggarwal R. Approach to asymptomatic creatine kinase elevation. Cleve Clin J Med. 2016;83(1):37-42.
- Kyriakides T, Aleksovska K, Angelini C, Argov Z, Claeys KG, de Visser M, et al. EAN 2024 Guideline on the Diagnostic Approach to Oligo/Asymptomatic HyperCKemia. Eur J Neurol. 2026;33(2):e70493.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 du 2 juin 2026 : acte 1520 (créatine phosphokinase).
- Cheeley MK, Saseen JJ, Agarwala A, et al. Statin intolerance: an overview of US and international guidance. Curr Atheroscler Rep. 2023;25(8):517-526 (compare EAS 2015, NLA 2022, recommandations canadiennes et latino-américaines).
- National Institute for Health and Care Excellence (NICE). Cardiovascular disease: risk assessment and reduction, including lipid modification. Guideline NG238, décembre 2023, sections 1.5 et 1.11.
- Zorginstituut Nederland (Pays-Bas). Farmacotherapeutisch Kompas : atorvastatine, consulté le 30/10/2026.
- Agence nationale de sécurité du médicament et des produits de santé. Résumé des caractéristiques du produit : Tahor (atorvastatine), rubrique 4.8. Base de données publique des médicaments, CIS 67143532.
- Agence nationale de sécurité du médicament et des produits de santé. Résumé des caractéristiques du produit : Lipanthyl 145 mg (fénofibrate), rubrique 4.8. Base de données publique des médicaments, CIS 69612398.
- Agence nationale de sécurité du médicament et des produits de santé. Résumé des caractéristiques du produit : Lipur 450 mg (gemfibrozil), rubrique 4.8. Base de données publique des médicaments, CIS 68696386.
- Agence nationale de sécurité du médicament et des produits de santé. Résumé des caractéristiques du produit : Risperdal 1 mg (rispéridone), rubrique 4.8. Base de données publique des médicaments, CIS 63605525.