7 Statin Side Effects You Need to Know: Drug Pros and Cons
Statin drug side effects using the “LIPITOR” mnemonic. Side effects of Atorvastatin (Lipitor), Rosuvastatin (Crestor), Pitavastatin (Livalo), Simvastatin (Zocor), and more!
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Statin Drug Side Effects
Statins are a class of medications that help lower cholesterol and reduce the risk of cardiovascular disease (strokes, heart attacks, etc.)
Common statin medications include Atorvastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin (Zocor), Pitavastatin (Livalo), Pravastatin (Pravachol), Fluvastatin (Lescol), and Lovastatin (Mevacor, Altoprev).
Like most medications, statins may come with side effects.
In this post, we will walk through the 7 main side effects of statins.
Statin Medication Examples: Drug list including Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin (Crestor), Fluvastatin (Lescol), Lovastatin (Altoprev, Mevacor), Pravastatin (Pravachol), and Pitavastatin (Livalo)
Keep in Mind…
Before we get started, a few things to keep in mind.
It is important to note people tolerate various statins and doses differently, and most people taking statins have no side effects.
Some symptoms may be due to other factors unrelated to the statin.
Therefore, it is important to discuss any concerns, symptoms, side effects, risks/benefits of statins with your provider.
Statins are effective in lowering cholesterol and reducing the risk of cardiovascular disease, and the benefits of statins usually outweigh the low likelihood of an adverse event for most people.
Do not stop taking your statin medication without talking to your provider first.
This post is for educational purposes only to learn about some of the reported side effects.
It is not intended to deter anyone from the use of statins.
Statin Disclaimer: Statins are effective in lowering cholesterol. Benefits usually outweigh risks of side effects. Lecture is for educational purposes only. Talk to your provider about any concerns, symptoms, side effects, risks/benefits, etc.
Statin Side Effects: “LIPITOR”
We came up with a simple mnemonic to help you remember the main side effects of statins.
The mnemonic is “LIPITOR” (which is a commonly prescribed statin), and this will make it easier to recall the side effects.
Statin Side Effects: Use the “LIPITOR” mnemonic to remember side effects such as liver problems, increased blood sugar/diabetes, muscle and joint pain, fatigue, etc.
What Are Statins?
Let’s briefly review what statins are, and then we’ll jump right into the side effects.
As mentioned above, statins are a class of medications that help lower cholesterol.
But where does the cholesterol in our body come from?
While some of our cholesterol comes from the food we eat, most of the cholesterol in our body is actually produced by the liver.
When our cholesterol levels are high, we can try to decrease those levels with lifestyle modifications.
This may include improving our diet, exercising, losing weight, quitting smoking, etc.
Statin Drugs: Statins are a class of medications that help lower cholesterol. Cholesterol comes from the food we eat and from the liver.
Statin Mechanism of Action
Sometimes our cholesterol levels remain high even with lifestyle modifications.
This is when statins can help.
Statins inhibit an enzyme called HMG-CoA reductase, which is an enzyme involved in cholesterol synthesis in the liver.
In other words, statins block the liver from producing cholesterol.
One of the reasons the liver requires cholesterol is to make bile.
Since the liver is not producing as much cholesterol while on a statin, the liver will take cholesterol out of the blood to be used to make bile.
This will reduce cholesterol levels even more.
Therefore, statins help decrease cholesterol levels in 2 ways:
By inhibiting cholesterol synthesis in the liver
By the liver taking cholesterol out of the blood to make bile
Statin Mechanism of Action: Statins inhibit HMG-CoA reductase, an enzyme involved in hepatic cholesterol synthesis. Lifestyle modifications can also help lower cholesterol.
While statins are great medications to lower cholesterol levels in many people, they can have side effects as well.
Let’s go through the 7 main side effects now.
1. Liver Effects
“LIPITOR” MNEMONIC
L = Liver Effects
Using the mnemonic “LIPITOR”, L stands for “Liver Effects”.
Statins may cause side effects to the liver including elevated liver enzymes.
The main liver enzymes affected are AST and ALT, which can be measured on a blood test.
This is why your provider may run a blood test to check your liver function and these levels before starting a statin.
The provider may also periodically monitor these levels while on a statin depending on your situation.
Elevated AST and ALT
AST and ALT are enzymes normally found in the liver as they are involved in hepatic function.
As mentioned above, statins may cause an increase in these liver enzymes.
This is thought to be due to leakage of the enzymes into the bloodstream rather than actual damage to the liver.
In rare cases, however, statins may cause inflammation or injury to the liver as well.
As AST and ALT leak into the bloodstream, higher than normal levels may be detected on a blood test.
AST and ALT are called transaminases.
Therefore, the elevation of liver enzymes is called transaminitis.
Transaminitis usually occurs when first starting a statin and typically does not cause symptoms.
In many cases, the increase in liver enzymes is temporary and will return to a normal range without having to stop the statin.
Statin Side Effects: Statins can cause an elevation of liver enzymes (AST and ALT) called transaminitis. It is usually temporary and asymptomatic.
If the elevated liver enzymes do not improve on their own, then they typically resolve by decreasing the statin dose or temporarily stopping the medication.
Once the liver enzymes are back to normal, many people can restart their statin medication without the liver enzymes increasing again.
The potential for developing transaminitis is typically dose-dependent.
This means the higher the dose of statin, the greater the risk of developing transaminitis.
Other contributing risk factors for elevated liver enzymes include preexisting hepatitis (inflammation of the liver), advanced age, presence of other chronic illnesses, etc.
Statin Side Effects: The elevated liver enzymes (transaminitis) is typically dose dependent, meaning the higher the dose of statin the higher the risk.
2. Increased Blood Sugar, Diabetes
“LIPITOR” MNEMONIC
I = Increased Blood Sugar
The next side effect is the first “I” in “LIPITOR” which stands for “Increased Blood Sugar”.
Normally
The pancreas produces and secretes a hormone called insulin.
Insulin is important in regulating blood sugar.
After a meal, insulin is secreted by the pancreas and binds to insulin receptors on cells.
This allows for cells to take up glucose from the blood and use it as a source of energy to help the cell function.
Blood Sugar: Normally the pancreas produces and secretes insulin. Insulin binds to cells, which allows for cells to take up glucose from the blood to be used as energy.
Statins
The use of statins may decrease insulin secretion from the pancreas, as well as make cells less sensitive to insulin.
As a result, cells will have a harder time taking up glucose from the blood.
This can lead to an increase in blood sugar.
Statin Side Effects: Statins may decrease insulin secretion and make cells less sensitive to insulin, thereby increasing blood glucose levels.
Having Said That…
The benefit of reducing cardiovascular disease (strokes, heart attacks, etc.) from a statin typically far outweighs the risk of developing a mild increase in blood sugar, even in those who already have diabetes.
The risks and benefits of statins vary from person to person, so it is always good to discuss with your provider.
Statin Drug Therapy: The benefits of statins usually outweigh the risk of adverse event, discuss with your provider.
3. Muscle and Joint Pain
“LIPITOR” MNEMONIC
P = Pain (Muscles and Joints)
The next side effect is the “P” in “LIPITOR” which stands for “Pain”.
This primarily involves muscle pain, but joint pain has been reported as well.
Some individuals on a statin may experience muscle pain, tenderness, cramps, spasms, or weakness.
Muscle pain may be bilateral and symmetrical.
Symptoms involve the skeletal muscles and not cardiac or smooth muscles.
This side effect has been shown to be dose-dependent.
This means the higher the dose of statin, the greater the potential risk of developing muscle pain.
Symptoms are typically reversible with discontinuation of the statin.
Some studies have shown individuals to report muscle pain when they were actually taking a placebo instead, so muscle pain from statins may not be as common as reported.
Statin Side Effects: Statins may cause joint pain, along with muscle pain, tenderness, cramps, spasms, or weakness.
4. Memory Loss, Dementia, Confusion
“LIPITOR” MNEMONIC
I = Impaired Memory
The next side effect is the second “I” which stands for “Impaired Memory”.
Some individuals have reported mild memory loss and confusion while taking a statin.
However, there is not much supportive data to suggest statins are the cause nor that statins lead to dementia.
Cognitive side effects are often labeled as “non-serious and reversible”.
Statin Side Effects: Mild memory loss and confusion have been reported, without significant supportive data to suggest statins were the cause.
5. Tiredness and Fatigue
“LIPITOR” MNEMONIC
T = Tiredness
Next we have the “T” which stands for “Tiredness”.
Some individuals have reported increased tiredness and fatigue while taking a statin.
Others have reported insomnia and difficulties falling/staying asleep.
Statin Side Effects: Statins may cause fatigue, tiredness, insomnia, troubles falling/staying asleep.
6. Other (Headaches, Nausea)
“LIPITOR” MNEMONIC
O = Other (Headaches, Nausea)
Next we have the “O” which stands for “Other”.
This is the “catch-all” category to include other mild side effects such as headaches, nausea, vomiting, diarrhea, dizziness, fevers, and infectious symptoms.
Statin Side Effects: Other mild side effects include headaches, migraines, nausea, vomiting, dizziness, fevers, and infectious symptoms.
7. Rhabdomyolysis
“LIPITOR” MNEMONIC
R = Rhabdomyolysis
Finally, we have the “R” in “LIPITOR” which stands for “Rhabdomyolysis”.
Rhabdomyolysis is a rare side effect, characterized by the breakdown of skeletal muscle.
As mentioned above, statins can cause muscle side effects including muscle pain and tenderness.
Rhabdomyolysis is the severe form of that.
Symptoms of rhabdomyolysis may include muscle pain or weakness, and dark urine.
Creatine kinase (CK) is an enzyme found in muscle cells and is involved in muscle cell function.
When muscle cells breakdown, as seen in rhabdomyolysis, creatine kinase is released into the bloodstream.
CK can be measured using a blood test, and elevated levels could be a marker for muscle damage.
Myoglobin is a protein found in muscle cells.
When muscles breakdown, myoglobin is also released into the bloodstream and excreted in the urine (myoglobinuria).
Myoglobinuria may cause the urine to appear dark.
Myoglobin can be measured as part of a urine test, and increased levels could suggest rhabdomyolysis.
Statin Side Effects: In rare cases, statins may cause rhabdomyolysis or muscle breakdown. Creatine Kinase (CK) and Myoglobin can be measured.
Possible risk factors for rhabdomyolysis include taking high doses of statins, advanced age, diabetes, taking certain medications with a statin, among others.
Complications of rhabdomyolysis include electrolyte abnormalities (such as high potassium levels), kidney injury, and arrhythmias to name a few.
Statin Side Effects: Symptoms, diagnosis, risk factors, and complications of rhabdomyolysis, a rare side effect of statins involving muscle breakdown.
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References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853001/
https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-018-1685-0
https://www.acc.org/latest-in-cardiology/articles/2018/12/12/07/23/statin-safety-and-adverse-events
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766774/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360430/
https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
https://www.mdpi.com/1422-0067/21/13/4725/htm
https://www.acc.org/latest-in-cardiology/articles/2018/04/09/13/25/assessing-severity-of-statin-side-effects
https://www.ncbi.nlm.nih.gov/books/NBK430940/