Is My Statin To Blame for Muscle Pain?

Cholesterol-lowering statins prevent heart attacks and stroke, making them one of the most recommended medications if you have cardiovascular disease or its risk factors.

But sometimes, you may experience statin muscle pain. That side effect may force you to stop taking them — and lose the beneficial protection they provide. Cardiologist Ashish Sarraju, MD, discusses the connection between statins and muscle pain.

Why do statins cause muscle pain?

We don’t know exactly why statins cause muscle pain in some people but not others. But you may find that you’re unable to tolerate even the lowest dose of two or more statins, due to the adverse effects they have on your muscles, joints or liver.

Statin muscle pain locations include the large muscles of your arms, shoulders, thighs or buttocks on both sides of your body.

“Within a month of starting statin therapy, you may feel aches or weakness in these areas,” says Dr. Sarraju.

There are two kinds of statins: lipophilic and hydrophilic.

• Lipophilic statins passively diffuse into the muscle. This means this type of medication doesn’t need any help or energy from your body. These statins, including atorvastatin, simvastatin and fluvastatin, seem more likely to cause muscle aches.
• Hydrophilic statins have to be actively transported by carrier proteins (which helps move the medication in and out of cells) and may cause fewer muscle aches. Hydrophilic statins include rosuvastatin and pravastatin.

About 5% of people who try statins experience muscle plan. It’s more common in people ages 65 and above, in women and in those taking the more potent statins.

5 ways to manage muscle aches from statins

If you’re experiencing muscle pain and think it may be from your statin medication, here are a few things you can discuss with your healthcare provider.

1. Check for interactions

Sometimes, certain foods or medications prevent your body from eliminating statins at the normal rate, causing statin levels in it to rise. Some common culprits include:

• Grapefruit juice
• Heavy alcohol consumption
• Calcium-channel blockers, like diltiazem and verapamil
• Antiarrhythmic drugs, like amiodarone and digoxin
• Antibiotics ending in -mycin
• Antifungal drugs ending in -azole
• Cholesterol-lowering fenofibrates

2. Take a lower dose

A little bit of a statin is better than none, so your doctor may recommend taking the lowest dose once a week.

For example, you may start off with 2.5 milligrams (mg) of rosuvastatin on a Monday. If you can tolerate it after a few weeks, then you can take 2.5 mg on Mondays and Thursdays. If that doesn’t bother you, then you can consider adding a third day. Another option is to stay on the twice-weekly schedule and raise the dose to 5 mg.

“By introducing statins slowly, 70% of ‘statin intolerant’ patients end up being able to take a statin, 60% of them can take it every day and 10% can take it three times a week,” notes Dr. Sarraju.

3. Switch medications

If you haven’t tried a different statin, talk to your doctor about switching to one.

Sometimes, muscle pain can be a “nocebo” effect, meaning a symptom related to the act of taking a pill rather than the pill itself, which can be resolved by stopping and “rechallenging” with a different agent. And it may be worth exploring other types of medications such as:

• Ezetimibe, which can lower LDL by approximately 20% to 25%
• PCSK9 inhibitors, such as alirocumab and evolocumab, which can lower LDL by 50%

These powerful drugs can lower LDL to rock-bottom levels without triggering muscle pain.

The only disadvantage is price. PCSK9 inhibitors are expensive, and some people may have difficulty getting their prescription approved. That’s why statins remain the more common choice for lowering LDL cholesterol.

And a quick note about CoQ10 supplements, which have been touted as reducing muscle pain in people who take statins: There’s just not enough scientific evidence that it helps.

4. Stay active

You may feel muscle soreness after a long workout (or if you’re just starting an exercise routine). But research shows that physical activity may help protect against muscle pain from statins.

5. Keep up with your lifestyle changes

If you have high cholesterol, there’s a good chance you’re already working on lifestyle changes like maintaining a healthy weight, following a heart-healthy eating plan and exercising. Focusing on these lifestyle changes may make it possible to lower your statin dosage (which may help reduce your muscle pain) or even stop statins altogether.

When to call your doctor

It’s time to talk to your healthcare provider if you continue to experience muscle pain or begin to notice other symptoms like:

• Weakness
• Fever
• Dark urine
• Jaundice

And while it may be tempting to stop your statin medication “cold turkey,” Dr. Sarraju shares this very important word of warning: Never stop taking a statin without your doctor’s guidance. It can greatly increase your chance of having a heart attack. Your doctor can advise you on how to safely decrease your dosage.