Statin side effects: Weigh the benefits and risks

Healthcare professionals often prescribe statins for people with high cholesterol. Statins help lower total cholesterol and reduce the risk of heart attack and stroke.

Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin, rosuvastatin (Crestor), and simvastatin (Zocor).

The body needs cholesterol. But having too much cholesterol in the blood raises the risk of heart attacks and strokes. Statins block an enzyme the liver needs to make cholesterol. This causes the liver to remove cholesterol from the blood.

While statins are effective and safe for most people, they have been linked to muscle pain, digestive problems, and mental fuzziness in some people. Rarely, they may cause liver damage.

If you think your statins are causing side effects, don’t just stop taking the pills. Talk to your healthcare team. A change in how much medicine you take or even a different type of medicine may help.

Muscle pain and damage

One of the most common complaints of people taking statins is muscle pain. You may feel this pain as a soreness, tiredness, or weakness in your muscles. The pain can be a mild discomfort, or it can be serious enough to make it hard to do your daily activities.

However, researchers have found a “nocebo effect” when it comes to people thinking they have muscle pain from statins. A nocebo effect means people who expect a negative side effect from a medicine report experiencing the potential side effect at higher rates than the medicine should cause.

The real risk of developing muscle pain from taking statins is about 5% or less compared with taking a placebo. A placebo is a pill that doesn’t contain medicine. Studies have found that people stopped taking the pills because of muscle aches even when they were taking a placebo. A strong predictor of if you’ll experience muscle aches when taking statins could be whether you read about the potential side effect.

Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis (rab-doe-my-OL-ih-sis). Rhabdomyolysis can cause extreme muscle pain, liver damage, kidney failure, and death. The risk of very serious side effects is extremely low. Only a few cases of rhabdomyolysis occur per million people taking statins. Rhabdomyolysis can occur when you take statins in combination with certain medicines or if you take a high dose of statins.

Liver damage

Sometimes, statin use could cause an increase in the level of enzymes in the liver. These enzymes signal inflammation. If the increase is only mild, you can continue to take the statin. Rarely, if the increase is severe, you may need to try a different statin.

Although liver problems are rare, your healthcare team may order a liver enzyme test before or shortly after you begin to take a statin. You won’t need any further liver enzyme tests unless you begin to have signs of trouble with your liver.

Contact your healthcare professional right away if you have unusual fatigue or weakness, loss of appetite, pain in your upper stomach, dark-colored urine, or yellowing of your skin or eyes.

Increased blood sugar or type 2 diabetes

It’s possible that your blood sugar, known as blood glucose, may increase when you take a statin. This may lead to type 2 diabetes. The risk is small but important enough that the U.S. Food and Drug Administration (FDA) has issued a warning on statin labels about blood glucose levels and diabetes.

The increase in blood sugar is small. And it does not cause concern unless it occurs when blood sugar levels are already high. People with prediabetes or diabetes may be more aware that their blood sugar levels rise when they start taking a statin.

But statins also prevent heart attacks in people with diabetes. The benefit of taking statins likely outweighs the small risk to have the blood sugar level go up. Talk to your healthcare team if you have concerns.

Neurological side effects

The FDA warns on statin labels that some people have developed memory loss or confusion while taking statins. These side effects reverse once you stop taking the medicines. There is limited evidence to prove a cause-effect relationship, and several studies have found that statins have no effect on memory. Talk to your care team if you experience memory loss or confusion while taking statins.

There also has been evidence that statins may help with brain function — in people with dementia, for example. This is still being studied. Don’t stop taking your statin medicine before talking to your healthcare professional.

Not everyone who takes a statin will have side effects, but some people may be at a greater risk. Risk factors include:

• Taking multiple medicines to lower your cholesterol.
• Taking medicines that interact with statins.
• Taking the highest dose of any given statin.
• Being female.
• Having a smaller body frame.
• Being age 80 or older.
• Having kidney or liver disease.
• Drinking too much alcohol.
• For some statins, drinking too much grapefruit juice.
• Having hypothyroidism or neuromuscular conditions, including amyotrophic lateral sclerosis (ALS).

Grapefruit juice has a chemical that can interfere with the enzymes that break down the statins in your digestive system. While you won’t need to cut grapefruit entirely from your diet, ask your healthcare team about how much grapefruit you can have.

Some medicines that may interact with statins and raise your risk of side effects include:

• Amiodarone (Pacerone), a medicine for irregular heart rhythms.
• Gemfibrozil (Lopid), another type of cholesterol drug.
• HIV treatments called protease inhibitors, such as ritonavir (Norvir).
• Some antibiotic and antifungal medicines, such as clarithromycin (Biaxin XL) and itraconazole (Sporanox, Tolsura).
• Some immunosuppressant medicines, such as cyclosporine (Sandimmune, Restasis).

Many medicines can interact with statins. Be sure your healthcare professional knows all the medicines you take before you start taking statins.

To relieve side effects believed to be caused by statins, your healthcare team may recommend several options. Discuss these steps with your care team before trying them:

• Take a brief break from statin therapy. Sometimes it’s hard to tell whether the muscle aches or other concerns you’re having are statin side effects or just part of the aging process. Taking a break can help you decide whether your aches and pains are due to statins or something else.
• Switch to another statin drug. It’s possible, although unlikely, that one statin may cause side effects for you while another statin won’t. Simvastatin (Zocor) may be more likely to cause muscle pain as a side effect than other statins when it’s taken at high doses.
• Change your dose. A lower dose may reduce some of your side effects, but it also may reduce some of the cholesterol-lowering benefits. Another option is to take the medicine every other day, especially if you take a statin that stays in the blood for several days. Talk to your healthcare professional to find out if this is right for you.
• Take it easy when exercising. If you aren’t used to exercising, this might raise your risk of muscle injury. It’s best to make changes in your exercise routine gradually. Exercise causes muscle pain too. So it is sometimes hard to know if the pain comes from the statin or the exercise in someone who just started an exercise program.
• Consider other cholesterol-lowering medicines. Although statins are the most effective medicines for lowering your cholesterol, other types of medicines are available. Sometimes, taking a combination of cholesterol medicines can provide the same result with lower doses of statins.
• Try coenzyme Q10 supplements. Coenzyme Q10 supplements may help prevent statin side effects in some people. But more studies are needed to learn about any benefits of taking them. Talk to your healthcare professional first to make sure the supplement won’t interact with any of your other medicines.

Although the side effects of statins can be annoying, consider the benefits of statins before you decide to stop taking your medicine. Remember that statins can lower your risk of a heart attack or stroke, among many other benefits, and the risk of life-threatening side effects from statins is very low. Among people with many heart conditions, those who take statins live longer.

If you have read about the potential side effects of statins, you may be more likely to blame your symptoms on the medicine, whether or not it truly caused your symptoms.

Even if your side effects are frustrating, don’t stop taking your statin medicine without talking to your healthcare professional first. Your care team may be able to make a different treatment plan that can help you lower your cholesterol without uncomfortable side effects.