Statin side eects: Weigh the benets and risks...

http://www.mayoclinic.org/diseases-conditions/h...

Diseases and Conditions

High cholesterol
Statin side effects can be uncomfortable, making it seem like the risks outweigh
the benefits of these powerful cholesterol-lowering medications. Consider the
risks and benefits.
By Mayo Clinic Staff

Doctors often prescribe statins for people with high cholesterol to lower their total
cholesterol and reduce their risk of a heart attack or stroke. Most people taking statins
will take them for the rest of their lives unless they can achieve normal cholesterol
levels through diet, exercise, weight loss and nutritional supplements. This can make
statin side effects more difficult to manage.
For some people, statin side effects can make it seem like the benefit of taking a statin
isn't worth it. Before you decide to stop taking a statin, discover how statin side effects
can be reduced.
Muscle pain and damage
The most common statin side effect 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 severe enough to make your daily activities difficult. For example, you
might find climbing stairs or walking to be uncomfortable or tiring.
Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis
(rab-doe-mi-OL-ih-sis). Rhabdomyolysis can cause severe muscle pain, liver damage,
kidney failure and death. Rhabdomyolysis can occur when you take statins in
combination with certain drugs or if you take a high dose of statins.
Liver damage
Occasionally, statin use could cause your liver to increase its production of enzymes
that help you digest food, drinks and medications. If the increase is only mild, you can
continue to take the drug. Rarely, if the increase is severe, you may need to stop
taking the drug. Your doctor might suggest a different statin. Certain other cholesterol-

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lowering drugs, such as gemfibrozil (Lopid) and niacin (Niacor, Niaspan), slightly
increase the risk of liver problems in people who take statins.
Although liver problems are rare, your doctor will likely order a liver enzyme test
before or shortly after you begin to take a statin. You shouldn't need any additional
liver enzyme tests unless you begin to have signs or symptoms of trouble with your
liver. Contact your doctor immediately if you have unusual fatigue or weakness, loss of
appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or
eyes.
Digestive problems
Some people taking a statin may develop nausea, gas, diarrhea or constipation after
taking a statin. These side effects are rare. Most people who have these side effects
already have other problems with their digestive system. Taking your statin medication
in the evening with a meal can reduce digestive side effects.
Rash or flushing
You could develop a rash or flushing after you start taking a statin. If you take a statin
and niacin, either in a combination pill such as Simcor or as two separate medications,
you're more likely to have this side effect. Taking aspirin before taking your statin
medication may help, but talk to your doctor first.
Increased blood sugar or type 2 diabetes
It's possible your blood sugar (blood glucose) level may increase when you take a
statin, which may lead to developing type 2 diabetes. The risk is small but important
enough that the Food and Drug Administration (FDA) has issued a warning on statin
labels regarding blood glucose levels and diabetes. Talk to your doctor 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
medication. Talk to your doctor if you experience memory loss or confusion. There has
also been evidence that statins may help with brain function in patients with
dementia or Alzheimer's, for example. This is still being studied. Don't stop taking your
statin medication before talking to your doctor.
Not everyone who takes a statin will have side effects, but some people may be at a
greater risk than are others. Risk factors include:
Taking multiple medications to lower your cholesterol
Being female
Having a smaller body frame
Being age 65 or older
Having kidney or liver disease

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Having type 1 or 2 diabetes

Drinking too much alcohol (More than two drinks a day for men age 65 and
younger and more than one drink a day for women of all ages and men older than
65)
It's unclear what causes statin side effects, especially muscle pain.
Statins work by slowing your body's production of cholesterol. Your body produces all
the cholesterol it needs by digesting food and producing new cells on its own. When
this natural production is slowed, your body begins to draw the cholesterol it needs
from the food you eat, lowering your total cholesterol.
Statins may affect not only your liver's production of cholesterol but also several
enzymes in muscle cells that are responsible for muscle growth. The effects of statins
on these cells may be the cause of muscle aches.
To relieve statin side effects, your doctor may recommend several options. Discuss
these steps with your doctor before trying them:
Take a brief break from statin therapy. Sometimes it's hard to tell whether the
muscle aches or other problems you're having are statin side effects or just part of
the aging process. Taking a break of 10 to 14 days can give you some time to
compare how you feel when you are and aren't taking a statin. This can help you
determine whether your aches and pains are due to statins instead of something
else.
Switch to another statin drug. It's possible, although unlikely, that one particular
statin may cause side effects for you while another statin won't. It's thought that
simvastatin (Zocor) may be more likely to cause muscle pain as a side effect than
other statins when it's taken at high doses. Newer statin drugs are being studied
that may have may have fewer side effects.
Change your dose. Lowering your dose may reduce some of your side effects,
but it may also reduce some of the cholesterol-lowering benefits your medication
has. It's also possible your doctor will suggest switching your medication to another
statin that's equally effective but can be taken in a lower dose. For example, if
you've successfully taken atorvastatin (Lipitor) for a long time at higher doses, your
doctor may keep you at this level. However, higher doses aren't recommended if
you're new to this medication.
Take it easy when exercising. It's possible exercise could make your muscle
aches worse. Talk to your doctor about changing your exercise routine.
Consider other cholesterol-lowering medications. Taking ezetimibe (Zetia), a
cholesterol absorption inhibitor medication, may help you avoid taking higher
doses of statins. However, some researchers question the effectiveness of
ezetimibe compared with statins in terms of its ability to lower your cholesterol.

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Don't try over-the-counter (OTC) pain relievers. Muscle aches from statins can't
be relieved with acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB,
others) the way other muscle aches are. Don't try an OTC pain reliever without
asking your doctor first.
Try coenzyme Q10 supplements. Coenzyme Q10 supplements may help to
prevent statin side effects in some people, though more studies are needed to
determine any benefits of taking it. If you'd like to try adding coenzyme Q10 to your
treatment, talk to your doctor first to make sure the supplement won't interact with
any of your other medications.
Statins can have several potentially dangerous interactions with other medications and
some foods. These interactions can make it more likely you'll have statin side effects.
These include:
All statins and grapefruit or grapefruit juice. Grapefruit juice contains a
chemical that can interfere with the enzymes that break down (metabolize) the
statins in your digestive system. This can be dangerous because it's uncertain
what the effect would be on your total cholesterol. You should still be able to have
some grapefruit or grapefruit juice, but talk to your doctor about limiting how much
grapefruit you can have.
Lovastatin (Mevacor, Altoprev) or simvastatin (Zocor) and amiodarone
(Cordarone). People taking the statins lovastatin or simvastatin, either alone or in
combination with amiodarone (Cordarone), a medication for irregular heart
rhythms, are at a greater risk of severe statin side effects, such as rhabdomyolysis.
All statins and gemfibrozil (Lopid). People who take both gemfibrozil (Lopid) and
a statin may be at a greater risk of statin side effects.
Mevacor (lovastatin) and HIV drugs. Medicines used to treat HIV (protease
inhibitors) should never be taken with Mevacor.
All statins and some antibiotic and antifungal medications. If you have a
fungal or bacterial infection, be sure to tell your doctor if you take a statin.
All statins and some antidepressant medications. It's possible that taking
antidepressants, such as nefazodone, and a statin could make you more likely to
have muscle aches.
All statins and some immunosuppressant medications. If you take a
medication to suppress your immune system, such as cyclosporine (Sandimmune),
and a statin, you may be more likely to have muscle aches.
Although statin side effects can be annoying, consider the benefits of taking a statin
before you decide to stop taking your medication. Remember that statin medications
can reduce your risk of a heart attack or stroke, and the risk of life-threatening side
effects from statins is very low.
Even if your side effects are frustrating, don't stop taking your statin medication for any
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period of time without talking to your doctor first. Your doctor may be able to come up
with an alternative treatment plan that can help you lower your cholesterol without
uncomfortable side effects.

References
1. Fernandez G, et al. Statin myopathy: A common dilemma not reflected in clinical trials. Cleveland
Clinic Journal of Medicine. 2011;78:393.
2. Rosenson RS, et al. Muscle injury associated with lipid lowering drugs. http://www.uptodate.com
/home. Accessed Jan. 28, 2013.
3. Sathasivam S. Statin induced myotoxicity. European Journal of Internal Medicine. 2012;23:317.
4. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs.
U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/ucm293101.htm. Accessed
Jan. 28, 2013.
5. Rosenson RS. Statins: Actions, side effects, and administration. http://www.uptodate.com/home.
Accessed Jan. 28, 2013.
6. FDA expands advice on statin risks. U.S. Food and Drug Administration. http://www.fda.gov
/ForConsumers/ConsumerUpdates/ucm293330.htm. Accessed Jan. 29, 2013.
7. Rosenson RS. Lipid lowering with drugs other than statins and fibrates. http://www.uptodate.com
/home. Accessed Jan. 28, 2013.
8. Phan BA, et al. Ezetimibe therapy: mechanism of action and clinical update. Vascular Health and Risk
Management. 2012;8:415.
9. Behrenbeck T (expert opinion). Mayo Clinic, Rochester, Minn. April 6, 2013.
10. Alcohol and public health: Frequently asked questions. Centers for Disease Control and Prevention.
http://www.cdc.gov/alcohol/faqs.htm#heavyDrinking. Accessed April 8, 2013.

Apr. 24, 2013

Original article: http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statinside-effects/art-20046013

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