Which cholesterol drug is safest?

Key takeaways

• Statins work by blocking the enzyme that makes cholesterol in the liver, which lowers low-density lipoprotein (LDL) cholesterol and may reduce the risk of heart attack and stroke.
• Pravastatin and fluvastatin may have fewer muscle-related side effects like pain or weakness, while simvastatin is generally well tolerated with milder digestive issues.
• If you experience side effects from statins, talk with a healthcare professional about alternative options rather than stopping suddenly, as discontinuing without supervision may affect your cholesterol levels.

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Overview

Statins are the most common medications typically prescribed to lower elevated cholesterol levels in the blood. They’re the first-line options for people with high cholesterol.

Statins work by stopping the action of the enzyme responsible for cholesterol production in the liver. This, in turn, can reduce the amount of low-density lipoprotein (LDL) cholesterol in your body. 

By lowering LDL cholesterol, often called “bad” cholesterol, statins help reduce the risk of atherosclerosis (a buildup of fat on artery walls) and cardiovascular events such as heart attacks and stroke.

Still, like other medications, all statins can have side effects. These may include muscle pain, nausea, liver damage, and memory difficulties. Some statins may be less likely to cause these effects, and there are other options if statins aren’t right for you.

What are the side effects of statins?

Statins are a class of medications. This means they all work in much the same way, meaning they’ll typically have similar side effects. The most frequently reported side effects of statins include:

• muscle pain and cramping
• muscle weakness
• fatigue (low energy)
• upset stomach or nausea
• headaches

While uncommon, more severe side effects of statin use may include:

• liver disease
• mental fatigue or confusion
• kidney failure

Another rare but severe side effect of statins is rhabdomyolysis, or rhabdo. This involves a rapid and intense muscle breakdown that may lead to irreversible disability.

Which statins have fewer side effects?

Although experiences vary from one person to the next, all drugs have the potential to cause unwanted side effects.

However, some studies suggest that certain cholesterol medications may be less likely to cause significant side effects than others. 

• Pravastatin: Studies suggest that pravastatin (Pravachol) may have fewer muscle-related side effects, such as muscle pain or weakness, than other cholesterol medications. This may make it a consideration for people who are prone to muscle discomfort or have physically demanding jobs.
• Fluvastatin: Another statin linked to fewer muscle-related side effects is fluvastatin (Lescol). Like pravastatin, it may be an option for people concerned about muscle discomfort.
• Simvastatin: Among the generally well-tolerated cholesterol medications is simvastatin (Zocor). The drug may still cause side effects such as muscle pain and digestive issues, but these side effects may be milder compared with other statins.

While these medications may have fewer side effects in some people, individual responses may still vary. This means that you could still experience certain side effects if you take these medications.

How you respond to statins can be influenced by a variety of factors, such as:

• your statin dosage
• your family and medical history
• your current health status
• other medications you may be taking
• your age

Pro tip: If you’re experiencing unwanted side effects on one statin, you can speak with your doctor about switching to another.

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Do some statins have fewer interactions with other drugs?

A drug interaction is a reaction where a substance, like a medication or a vitamin, changes the way a medication works in your body. Interactions may make a drug less effective, make it too strong, or cause unexpected side effects.

Different medications have different interactions because of the various ways drugs are processed by your body. For example, some statins are broken down by a specific enzyme in your liver. When other medications use this same enzyme, statin levels can build up in your bloodstream, increasing your risk of side effects.

Some statins are less likely to have this effect because they’re not broken down by this enzyme, or they rely less on the enzyme to be broken down. These statins include:

• pravastatin (Pravachol)
• rosuvastatin (Crestor)
• fluvastatin (Lescol)

Let your doctor know about all the medications you take when you’re prescribed a statin. Your doctor can find out about any interactions and prescribe an appropriate statin for your situation.

Do other cholesterol medications have fewer side effects?

Statins are the first-line choice for cholesterol management, but they aren’t the only option. If statins aren’t right for you, your doctor might prescribe an alternative.

You may also want to ask your healthcare professional about other ways to manage high cholesterol, including:

• stress management
• exercise
• supplements
• vitamins

Bempedoic acid

Bempedoic acid (Nexletol) is a newer medication used to lower cholesterol levels. Doctors prescribe it for people who can’t tolerate statins or need additional cholesterol management. 

However, while it has shown promise in reducing LDL cholesterol levels, bempedoic acid may also lead to side effects, although they may differ from those of statins.

PCSK9 inhibitors

PCSK9 inhibitors are injectable medications that help your liver get rid of LDL cholesterol. They’re typically only prescribed to people who can’t tolerate statins due to side effects or interactions, or if statins don’t work well enough.

Examples include:

• alirocumab (Praluent)
• evolocumab (Repatha)
• enlicitide (Lipfendra)

Some side effects of PCSK9 inhibitors may include:

• flu-like symptoms
• back or muscle aches
• injection site reactions

Summary

Although all medications can have side effects, research indicates that certain statins may have fewer side effects than others. Pravastatin and fluvastatin are associated with fewer muscle-related discomfort, while simvastatin may cause fewer gastrointestinal issues. 

However, responses to cholesterol medications can vary from person to person and may be influenced by many factors.

Talk with your doctor to find out which cholesterol medications may work best for you and have the lowest risk of certain types of side effects. They can help you make an informed choice, weighing the benefits against the potential risks of high cholesterol.

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