What Are the Side Effects of Statins?

Statins are widely used cholesterol-lowering drugs that can reduce the risk of major heart-related health problems.

Though statins generally have a good safety profile, they can cause side effects in some people. Still, healthcare providers believe that the benefits of statins outweigh the risks related to side effects. There are options for managing side effects if they become bothersome.¹

This article will review the side effects of statin drugs and how to manage them.

What Are Statins?

Statin medications are used with diet and exercise to treat hypercholesteremia (high blood cholesterol levels).

Statins belong to the prescription drug class called hydroxymethylglutaryl-coenzyme A (HMG CoA) reductase enzyme inhibitors. They work to reduce the production of cholesterol in the liver.²

Statins lower low-density lipoprotein (LDL) cholesterol, also known as bad cholesterol, and triglyceride levels in the blood. They also increase the concentration of high-density lipoprotein (HDL), also known as good cholesterol.²

Statins are also widely used and have proved effective in preventing atherosclerotic vascular diseases, primarily by reducing plasma LDL concentrations.

The U.S. Food and Drug Administration (FDA)-approved and marketed single-ingredient products statins include:³

• Lipitor (atorvastatin)
• Lescol XL (fluvastatin extended release)
• Altoprev (lovastatin extended release)
• Livalo (pitavastatin)
• Crestor (rosuvastatin)
• Zocor (simvastatin)

Other combination products include:³

• Advicor (lovastatin/niacin extended release)
• Simcor (simvastatin/niacin extended release)
• Vytorin (simvastatin/ezetimibe)

Side Effects of Statins

Statins have a good safety and efficacy profile for improving cholesterol levels. However, they can cause some side effects.

The benefits of taking statins generally outweigh the side effects, but they can still be bothersome for some people. In most cases, they are reversible but sometimes require stopping therapy for a while.

Some more common mild side effects of statins include:⁴

• Constipation
• Diarrhea
• Dizziness
• Gas
• Headache
• Muscle/joint aches
• Nausea
• Upset stomach

Other potential reversible side effects include:⁵

• Memory loss and confusion  
• Increased blood sugar
• Increased hemoglobin A1C enzyme levels

In some people, statins can cause a few severe side effects. However, these are generally uncommon. Some other rare severe side effects of statin include:⁶

• Liver damage
• Kidney damage
• Muscle disorders
• Hemorrhagic strokes

The risks of these are rare and associated with higher drug doses. Healthcare providers believe that statins' benefits outweigh the risks of these side effects.⁶

Muscle Pain and Soreness

Some people report mild muscle pain and soreness while taking statins. However, some studies suggest that most reports of muscle pain may not actually be due to the statin itself.⁷⁸

If the side effects become especially bothersome, your healthcare provider might reduce the dose.

Rarely, severe cases may involve a type of muscle disorder called rhabdomyolysis, which can cause the following symptoms:⁹¹⁰

• Severe muscle cramps, aches, or pains
• Dark-colored urine
• Extreme weakness or fatigue

Risk Factors for Side Effects

Statins are relatively safe for most people. However, they are not recommended in certain cases. Some people are at an increased risk of side effects. This includes if you:¹¹

• Take other medicines to lower cholesterol levels or drugs that interact with statins
• Are pregnant
• Are 80 years or older
• Have kidney or liver disease
• Consume alcohol in excess
• Have hypothyroidism
• Have a neuromuscular disorder, such as amyotrophic lateral sclerosis (ALS)¹²

Drug and Food Interaction

Statins may interact with certain drugs and cause an increased risk of muscle injury:⁵

• Cholesterol-lowering drugs known as fibrates
• Higher doses of niacin
• Ranexa (ranolazine), used to treat angina
• Colchicine, a medicine for treating gout

The FDA has updated the Lovastatin label for interactions with other drugs and their dose limitations to reduce the risk of muscle injury.¹³

Follow a healthy diet while taking statins. This includes eating less fat in the diet.

Avoid drinking large amounts of grapefruit juice while taking statins. Excessive grapefruit juice consumption can raise the amount of the drug in the blood and increase the risk of muscle disorders. However, an 8-ounce (240-milliliter) glass of juice or one grapefruit can be safely consumed.⁴

How to Manage Side Effects

In many cases, the benefits of statin therapy outweigh the risk of adverse effects. However, in some people, the side effects may be severe enough to drive healthcare providers to permit the discontinuation of statin drugs.¹

To relieve side effects that are believed to be caused by statins, discuss these steps with your healthcare provider:

• Stopping statin therapy to reduce the side effects 
• Switching to another cholesterol-lowering drug
• Reducing the dose
• Making lifestyle changes to reduce cholesterol levels, such as eating a low-fat diet, doing regular exercise, and quitting smoking⁶

Some also believe that taking coenzyme Q10 (coQ10) supplements can help fight muscle disease.⁶ However, the data on this has been mixed, and many studies don't indicate much benefit from taking CoQ10 supplements for this purpose.¹⁴

Statins can lower the risk of a heart attack or stroke, and the risk of life-threatening side effects from statins is very low.

Summary

Statins are a widely used group of drugs that are generally well tolerated. Like any other type of drug, they may cause a few side effects in some people.

The side effects of statins, such as muscle pain, memory loss, or a slight increase in the risk of new-onset diabetes and the potentially increased risk of stroke, are negligible when compared with the benefits that the medication provides.

Tell your healthcare provider about any other drugs you take before taking statins.

Sources:

1. Hussain A, Kaler J, Ray SD. The benefits outweigh the risks of treating hypercholesterolemia: the statin dilemma. Cureus. 15(1):e33648. doi:10.7759/cureus.33648
2. MedlinePlus. Statins.
3. U.S. Food and Drug Administration. Statins. December 16, 2014.
4. MedlinePlus. How to take statins.
5. U.S. Food and Drug Administration. Cholesterol-lowering drugs gets labelling changes. May 22, 2015.
6. Hu M, Cheung BMY, Tomlinson B. Safety of statins: an update. Ther Adv Drug Saf. 2012;3(3):133-144. doi:10.1177/2042098612439884
7. Cholesterol Treatment Trialists' Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. Lancet. 2022;400(10355):832-845. doi:10.1016/S0140-6736(22)01545-8.
8. Pergolizzi JV Jr, Coluzzi F, Colucci RD, et al. Statins and muscle pain. Expert Rev Clin Pharmacol. 2020;13(3):299-310. doi: 10.1080/17512433.2020.1734451
9. Safitri N, Alaina MF, Pitaloka DAE, Abdulah R. A narrative review of statin-induced rhabdomyolysis: molecular mechanism, risk factors, and management. Drug Healthc Patient Saf. 2021;13:211-219. doi:10.2147/DHPS.S333738.
10. Centers for Disease Control and Prevention. Rhabdomyolysis. February 8, 2023.
11. Ramkumar S, Raghunath A, Raghunath S. Statin therapy: review of safety and potential side effects. Acta Cardiol Sin. 2016;32(6):631-639. doi:10.6515/acs20160611a
12. Crisan E, Patil VK. Neuromuscular complications of statin therapy. Curr Neurol Neurosci Rep. 2020;20(10):47. doi:10.1007/s11910-020-01064-0
13. U.S. Food and Drug Administration. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. January 19, 2016.
14. Wei H, Xin X, Zhang J, et al. Effects of coenzyme Q10 supplementation on statin-induced myopathy: a meta-analysis of randomized controlled trials. Ir J Med Sci. 2022;191(2):719-725. doi:10.1007/s11845-021-02651-x

Important Notice: This article was originally published at www.verywellhealth.com by Ayesha Gulzar, PharmD where all credits are due. Medically reviewed by Alex Yampolsky, PharmD

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