Statins lower cholesterol and reduce the risk of heart attack and stroke. They include atorvastatin, simvastatin and rosuvastatin. Most people take them without difficulty, and the effect people ask about most is muscle aching.
Common side effects during long-term use
- Muscle aches, stiffness or tenderness, typically in the large muscles of the thighs, shoulders or upper arms, and usually on both sides
- Headache
- Nausea, indigestion, constipation, diarrhoea or wind
- Joint pain
- Sleep disturbance or unusual dreams
On muscle symptoms, the honest position is more interesting than either side of the usual argument. Muscle aching is a genuine and recognised statin effect, and it is also extremely common in the general population, particularly with age. Careful studies in which people took a statin and a dummy tablet in alternating periods, without knowing which was which, found that many reported similar symptoms during both. That does not mean the symptoms are imagined. It means the statin is not always the cause, and that assuming it is can lead someone to abandon a medicine that was protecting them.
The practical implication: a supervised pause and restart, or a switch to a different statin, is often the way to find out. Simply stopping and concluding is the less informative option. See statins and muscle weakness and cholesterol tablets and muscle pain.
A small increase in blood sugar occurs in some people, and a small number develop type 2 diabetes who might not otherwise have done. For most people at raised cardiovascular risk this is outweighed by the benefit, but it is a fair thing to ask about.
Serious or persistent symptoms to discuss with a clinician
Get urgent help for severe muscle pain or weakness together with dark, tea-coloured urine, particularly with fever or feeling generally unwell. This pattern can indicate rhabdomyolysis, a rare breakdown of muscle tissue that can damage the kidneys.
What distinguishes it from ordinary aching is severity, genuine weakness rather than soreness, and the change in urine colour.
Also contact a doctor for yellowing of the eyes or skin, dark urine with pale stools, persistent nausea with upper abdominal pain, new memory or confusion problems, or a rash that blisters or peels. See statins and the liver.
Dose changes, missed doses and monitoring tests
Monitoring usually includes cholesterol and liver blood tests, with a muscle enzyme test added if muscle symptoms occur.
If muscle symptoms appear, tell your prescriber before stopping. The usual approaches are a lower dose, a different statin, alternate-day dosing, or a planned pause to see whether symptoms actually resolve. Many people who could not tolerate one statin do fine on another, so a single bad experience does not rule out the class.
Statins should be stopped if you become pregnant or are planning pregnancy. Discuss this in advance if it may apply.
Interactions with OTC medicines and supplements
- Grapefruit and grapefruit juice, which raise levels of some statins, notably simvastatin and atorvastatin, and increase muscle side-effect risk. Rosuvastatin is affected far less.
- Some antibiotics and antifungals. Certain ones markedly raise statin levels, and a short course may warrant a temporary pause. Always mention your statin.
- Other cholesterol medicines, where combinations can add muscle risk.
- St John’s Wort, which can reduce the effect. See St John’s Wort interactions.
- Alcohol, where heavy use adds liver strain.
What to ask your doctor before changing treatment
- Are my muscle aches likely to be the statin, and how would we find out?
- Would a lower dose, a different statin, or alternate-day dosing help?
- What is my actual cardiovascular risk, and what does this change about it?
- Do I need to avoid grapefruit with the one I am on?
- When were my liver tests last done?
Related chronic medication guides
- Cholesterol medication side effects
- Chronic medication side effects
- Managing chronic medication side effects
- Should I stop my chronic medication
- Report a side effect in South Africa
See also atorvastatin, simvastatin and rosuvastatin.
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.