How to manage the side effects of statins

You can’t live without cholesterol. Every cell in your body needs it. But too much is a problem. High levels can lead to a heart attack or stroke. That’s why millions of people take statins. The medications keep cholesterol in check.

Statins work through the liver to prevent cholesterol from forming. According to the American Heart Association (AHA), they simultaneously reduce LDL (bad) cholesterol and triglycerides while raising your body’s HDL (good) cholesterol. And they’re very common: 1 in 4 Americans over the age of 40 take a statin, says the AHA.

You may recognize statin names such as Lipitor® (atorvastatin) or Crestor® (rosuvastatin calcium). But there are many others. (No matter which medication you’re on, use the Optum Perks prescription discount card to save up to 80% at the pharmacy.)

But while the medications do a ton of good, many users report negative side effects, such as muscle aches, pains and weakness.

To help explain the balance between risk and benefit, we spoke to Alyssa M. Wozniak, PharmD. She’s a clinical assistant professor at the D’Youville School of Pharmacy in Buffalo, New York.

Q: What are the benefits of taking statins?

Wozniak: For people who have heart disease, or those who have had a heart attack or stroke in the past, statins can reduce the risk of another heart attack or stroke. Statins also benefit people who are at risk for a stroke.

Q: How common are the side effects?

Wozniak: Up to 30% of patients may experience pain or weakness in their muscles. It can be a mild tiredness or discomfort, or it can be severe enough to make your daily activities difficult. These side effects usually occur within 4 to 6 weeks of starting a statin, but they can occur even after several years.

Recommended reading: Do statins cause weight gain?

Q: Why do side effects occur?

Wozniak: There are many factors that can increase the risk of experiencing side effects. Think drug or food interactions or reduced kidney function. Grapefruit juice, for instance, should be avoided for patients taking simvastatin or lovastatin. Before taking a statin, you should talk to your doctor or pharmacist to be sure you’re aware of the potential interactions.

Beyond that, we don’t really understand why some patients experience side effects and others don’t. But researchers are looking into it. Several studies are focusing on the role of a patient’s genetics. Others have investigated whether side effects occur due to statins’ effects on coenzyme Q10. This is a substance found in the muscles that helps produce energy. Statins may lower the amount of coenzyme Q10 in the muscles, and this could contribute to muscle pain.

Some statins may be more likely than others to cause drug interactions that can lead to muscle pain. Statins with fewer drug interactions generally include rosuvastatin (Crestor®), pravastatin (Pravachol®) and fluvastatin (Lescol®). (You can click on each link to download a coupon instantly.)

Q: People who experience statin side effects may have to cut back on exercise due to muscle pain or weakness. Can this make cholesterol worse?

Wozniak: It doesn’t help the problem. A healthy lifestyle is the best way to prevent heart disease. And exercise in particular can help lower cholesterol levels.

But if patients experience muscle pain, they shouldn’t just quit taking statins. They should talk to their doctor, who can help find a plan to reduce side effects.

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Q: What can you expect when you tell your doctor about your side effects?

Wozniak: First, your doctor will work with you to ensure that your dose is adequate based on your risk factors for heart disease. She will ask you to describe your symptoms to assess muscle pain severity and to try to determine whether it might be related to the statin therapy itself, or possibly due to another cause. If your symptoms sound severe, she may order lab work.

Your doctor may also temporarily stop the statin to see if you improve. If you do, she may recommend restarting at a lower dose or switching to a different one. If you are still having side effects, your doctor may cut back even more or try a non-statin prescription.

There are other medicines and supplements that can lower cholesterol. But it is important to figure this out with your doctor. Statins are typically the first-choice therapy.

Q: Are there other natural ways to manage statin side effects?

Wozniak: You could try an over-the-counter coenzyme Q10 supplement. There is conflicting evidence in studies on how well this works for muscle pain, but it may reduce the risk of statin-related side effects. If you would like to try coenzyme Q10, consult your doctor or pharmacist to ensure there are no drug interactions with your other medications.

Q: Are there any strategies for getting off statins entirely?

Wozniak: Whether you’ll be able to stop taking a statin depends on several factors. It often centers on whether you already have heart disease or if you’ve had a stroke or heart attack. If you’re in this high-risk group, statins may be considered a first-choice therapy.

Some people do not yet have heart disease, but they do have factors that increase their risk of heart attack or stroke. For them, a heart-healthy diet and exercise can help lower “bad” cholesterol and reduce the risk for heart disease. In this case, you might be able to work with your doctor to reduce or go off statins.

But you should know that there are some heart-disease risk factors that might not be in your control, such as age, gender and race. You should exercise and eat a healthy diet, because those things will help you live a long, healthy life. But don’t be discouraged if you don’t see change fast enough. A low statin dose may still be necessary to keep your cholesterol low.

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