Fortunately, side effects with statins are not common, occurring in only in up to 3% of people individuals in randomized clinical trials on statins and most are not serious The most common side effects of statins include:
- Gastrointestinal symptoms such as constipation, nausea, or indigestion.
- Upper respiratory type symptoms.
- Muscle side effects:
- Myalgia or soreness or aching without associated injury (occurs in 1.5-3.5% of patients taking statins in clinical trials. However observational studies suggest that this may be present to some degree and up to 10% of individuals).
- Myopathy or muscle soreness associated with muscle injury (occurs in less than 1/10th of a half of percent of patients taking statins).
- Rhabdomyolysis, the most severe form of myopathy, is very infrequent (occurs 5 in very 10,000 patients taking statin drugs).
- Liver abnormalities (occur in less than 1 percent of people taking statins); found during blood testing and are in most cases reversible with stopping the medication; may even improve with continuing to take the statin drug at the same dose or a reduced dose.
- Diabetes – some patients who are at risk for diabetes have a moderate risk of developing diabetes after starting a statin. Benefits and risks of statin use in these patients should be discussed with the patient. In general it is felt that the benefits of statin therapy in high-risk patients outweigh the risk of diabetes development.
Patients are considered statin intolerant if they develop side effects and are unable to continue to use a statin medication or able to only tolerate lower doses.
Who is at risk for statin intolerance?
- The elderly, over 75 to 80 years
- Having a small body frame or being frail
- Having other medical conditions such as kidney disease or liver disease
- Large amounts of grapefruit or grapefruit juice consumption
- Taking some medications like certain types of drugs used to treat fungal infection, some antibiotics, and some heart medications
These risk factors may increase the levels of stain in the blood and therefore be associated with a higher risk of side effects, so it’s important to let your doctors know any other medications or supplements you are taking.
What to do if you think you are statin intolerant
If you think you are statin intolerant, you should see a lipid specialist (doctor who specializes in the treatment of abnormal cholesterol values) to work with you to achieve your lipid goals.
Cleveland Clinic’s Preventive Cardiology team have found that almost 73 percent of patients who were thought to be intolerant to two or more statin medications were able to obtain the benefits of statin drugs through a careful program. Patients were taken off the statin causing side effects and either re-started on the same drug at a very low dose; or instructed to take a different statin.
Patients who experience muscle discomfort may take Coenzyme Q-10 (CoQ-10) to help relieve the symptoms. Some studies show that patients may better tolerate statins when they take them with CoQ-10. Coenzyme Q-10 is fat-soluble, and it’s better absorbed when taken with a meal containing mono- or polyunsaturated fat. Talk to your doctor before taking Coenzyme Q-10. He or she may want to check to make sure you are having muscle discomfort and not muscle damage first.
Your doctor will discuss these potential side effects with you. If you have any questions about statins or side effects, please be sure to talk to your doctor about your concerns.
Statins are not a Cure-All
Statin medications are not meant to be used as a substitute for a healthy lifestyle that includes regular exercise (about an hour each day), smart food choices and maintaining a healthy weight (body mass index [BMI] below 25). Healthy lifestyle habits also include eating breakfast every day, weighing yourself at least once a week and watching less than 10 hours of TV per week.
Brisk walking is a great form of exercise. Wearing a pedometer can help motivate you to increase the amount of walking you do. A good goal is to walk 10,000 steps per day, which is five miles (2,000 steps per mile, on average).
A heart-healthy diet is the Mediterranean diet, which includes an abundance of fresh vegetables and fruits, healthy fats, moderate amounts of fish and poultry, whole grains, nuts and only small amounts of lean meats. Trans fats should be avoided.
A note about supplements
People often want to take non-medication alternatives to statins. But, be cautious of non-prescription supplements such as red yeast rice. This contains an active ingredient similar to the statin Lovastatin, and therefore should only be used only under your doctor’s supervision, especially if you’ve experienced side effects to prescription statins. In 2007, the FDA released a warning regarding red yeast rice.
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