Most people tolerate these drugs very well. However, as is true with
all drugs, some people develop side effects.
WELL-KNOWN SIDE EFFECTS: LIVER AND MUSCLE
The side effects that your doctor will be most
familiar with are:
- Liver: Changes in liver
function occur in a small fraction of people; your doctor will probably
monitor blood tests to check that your liver continues to function well.
If the liver function becomes too abnormal, your doctor will stop the drug.
The liver is expected to return to normal function.
- Muscle: Muscle symptoms are
common with statin drugs. “Myopathy,"
involving actual damage to muscle tissue, can be very serious. For
this reason, if you develop new muscle pain, weakness, or tenderness on the
drugs you should inform your doctor immediately. Very rarely, if myopathy occurs and the drugs are not stopped, a very dangerous condition,
called “rhabdomyolysis”, can occur that can sometimes be fatal. Myopathy
and rhabdomyolysis are more common if people are on other cholesterol lowering
drugs, particularly niacin or gemfibrozil (or other “fibrates”), as well as a
statin. Certain other classes of drugs in combination with statins can also
increase the risk of
Things You Should Know
If you develop muscle symptoms it is very important that you let your doctor
know immediately; your doctor will probably draw a blood test called a “CK” (creatine
kinase) test that assesses whether muscle damage is present. CK is
a muscle enzyme, and the test is also done during suspected heart attacks, to
test for damage to the heart muscle. It is important to be aware that normal
levels of "CK" do not exclude a relation to statins.
If you get an infection and are put on
antibiotics or antifungal agents, make sure the prescribing doctor knows you are
on statins, because several antibiotics and antifungal drugs can interact with
the statin drugs to cause problems. In fact, it is a good idea with each
new drug you are started on to be sure the doctor is familiar with the rest of
your drug list. Also, if you become seriously ill or are scheduled for
surgery, you should talk to your doctor about stopping your statin drug until
you are better, or well on the road to recovery.
You should be aware that grapefruit juice affects
metabolism of most statins (but not pravastatin) and can markedly increase blood
levels, so grapefruit juice may be best avoided while you are on statins. This
is not true for other citrus juices.
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LESSER-KNOWN SIDE EFFECTS
Memory, Thinking and Concentration
people report changes in memory, attention, or concentration on statins.
They may have trouble finding the right word; may forget tasks they started to
do; and may have trouble following conversations. Some people describe "holes in
their memory." Some people worry that they are developing Alzheimer's. Of
course, since people on statin drugs are often older, and may be experiencing
age-related loss of memory, it makes it difficult to know whether the drugs are
responsible. Many people report improvement in memory and thinking when
they stop the drug; or improvement if they go on a lower dose. These
findings suggest that the drug is responsible.
As of now there there are two randomized controlled
trials that have looked at thinking on these drugs. One was published in May 2000
in the journal called
American Journal of Medicine. Dr. Matthew Muldoon, at the University of
Pittsburgh, showed that statin drugs on average reduces “cognition,” that is to
say, people who were on a statin drug did worse on tests of thinking and memory
ability, even though they started out the same as those who were put on a
placebo pill. These effects were “significant” statistically. On
average the effects were considered to be small, but of course some people have
no alteration, while others have bigger losses in memory and thinking. A
second study by Dr. Muldoon shared similar findings. However, in another
statin trial, no effect was seen on cognitive function. That study, in
persons over 70, was not expressly designed to assess the effect of statins on
thinking, but it did assess cognitive function.
people report changes in mood on statins. These include loss of interest
in activities and loss of interest in social involvement. Some people
report frank depression, but it is not known if these effects are more common in
people on statins than in people who are not. However, some people
reliably become down when on the drugs, and better when off, so that for these
people there appears to be a relationship. It is possible that some people
may also get a boost to their mood with low cholesterol, although this is less
commonly reported. In some cases violence, psychosis, and suicide have
been reported. We have published a small case series describing several
instances of severe irritability arising on statins, resolving when statins were
stopped, and returning when statin use was resumed.
Although muscle pain is a
well-recognized side effect of these drugs (and one that should be reported, so
tests can be done), other pain effects have been reported by many people on
statins, but have not been studied extensively include headaches, joint pains,
and abdominal pain.
Studies have confirmed that
peripheral neuropathy (tingling and numbness or burning pain) may occur with
Sleep problems, sexual function problems,
fatigue, dizziness and a sense of detachment are also reported with these
drugs. Additionally, people have mentioned experiencing swelling, shortness of
breath, vision changes, changes in temperature regulation,
weight change, hunger, breast enlargement, blood sugar changes, dry skin,
rashes, blood pressure changes, nausea, upset stomach, bleeding, and ringing in
ears or other noises.
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STATINS AND CoQ10
Although symptoms usually resolve on stopping the drug, for a
proportion of those who have contacted us, muscle symptoms – pain or
weakness – or peripheral neuropathy may persist when the drugs are
discontinued. There is published scientific evidence that statins lower
coQ10 levels in a dose-dependent fashion; that low levels of coQ10 relate to
muscle and brain pathology; and that restoration of coQ10 may lead to
diminution of symptoms in those with muscle or cognitive problems. We have
received a number of anecdotal reports from statin users who developed
muscle problems who report benefit from adequate doses (which vary from
person to person) of coenzyme Q10 supplements, which are available over the
counter. There is also one small controlled study that reported benefit of
coQ10 to statin muscle symptoms. There are also controlled studies showing
benefit of coenzyme Q10 supplementation in persons who have low levels of
this biochemical not necessarily related to statin use. Coenzyme Q10 should
be in gelcaps, in an oil or vitamin-E base to be absorbed.
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WHAT TO DO IF YOU THINK YOU ARE HAVING AN ADVERSE
- If you have muscle pain or weakness, or brown urine (or change in color of
urine), call your doctor immediately; you will probably need to get a "CK"
- For any symptom that is bothersome to you, call your doctor and and
schedule an appointment to discuss the symptom.
- If you think the effect may be caused by the drug, ask your doctor about
doing a test in which you stop the drug, or reduce the dose; see if the effect
improves. If you and your doctor deem it is safe to do so, you might see if
the symptoms return or worsen upon resuming the drug (sometimes a different
statin drug or a lower dose, or a non-statin drug are all that are needed). If the doctor
is unwilling to reduce the dose, and you are willing to try to increase the
dose, you might increase the dose and see if the symptoms get worse. If the
symptoms are severe, it is best to avoid this. If your doctor is very
skeptical that the effect could result from the drug, and you are willing, you
can do an "n-of-1" trial in which, on the doctor's order the pharmacy gives
you placebo or drug, for at least two months, and neither you nor your
doctor are told which. If you can say when the problem gets worse or better,
this may help persuade your doctor. Know that it is your health and it is
always your choice whether to take a drug. If your physician does not take
your concerns and preferences into account, consider looking for a different
- If the symptoms seem related to the drug (especially if the above testing
suggests a connection) you and your doctor will need to work together to
decide whether the need for the drug exceeds the problems and effects on
quality of life that the drug produces. The final choice is yours.
- Please contact us and let us know about your side effects; the more we
know, the more we can help others.
- Some doctors are not familiar with the evidence that statin drugs or
cholesterol drugs can cause problems with memory, pain, irritability, or sleep. You may need to educate them, and we are happy to help.
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