Statins
Why are they Prescribed?
There are prescribed for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke.
Your GP will assess your chance of cardiovascular disease looking at a range of factors which include age, sex, ethnic group, weight, height, whether you smoked, blood pressure, blood cholesterol levels and any family history.
The GP will also take into account any long term conditions such as diabetes, kidney disease, rheumatoid arthritis and atrial fibrillation.
The Benefits and Side Effects
Statins are very effective at lowering cholesterol and protecting against a heart attack and stroke. There are some people who complain of side effects such as muscle aches.
Other side effects described can be digestive problems and some mental fuzziness.
The names of the common drugs are
Atorvastatin (Lipitor)
Fluvastatin (Lescol XL)
Lovastatin (Altoprev)
Pitavastatin (Livalo),
Pravastatin (Pravachol),
Rosuvastatin (Crestor, Ezallor)
Simvastatin (Zocor, FloLipid).
What do statins do?
Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood.
What do I do if I think I have side effects?
Do not just stop taking the pills. Make an appointment to talk to your doctor to see if a change of dosage would help or change to a different type of medication.
Side Effects
Muscle pain and damage
One of the most common complaints of people taking statins 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.
Statins can occasionally cause muscle inflammation (swelling) and damage. Speak to your doctor if you have muscle pain, tenderness or weakness that can’t be explained – for example, pain that isn’t caused by physical work.
Your doctor may carry out a blood tests to measure a substance in your blood called creatine kinase (CK), which is released into the blood when your muscles are inflamed or damaged.
If the level of CK in your blood is more than 5 times the normal level, your doctor may advise you to stop taking the statin. Regular exercise can sometimes lead to a rise in CK, so tell your doctor if you’ve been exercising a lot.
Once your CK level has returned to normal, your doctor may suggest you start taking the statin again, but at a lower dose.
The risks of this are just 5% but many more people give them up because they have muscle aches. However, you must remember that the kind of age of person prescribed statins will also be the age of person who will naturally have aches and pains developing.
Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis.This can cause severe muscle pain, liver damage, kidney failure and death. The risk of this is extremely low just a few cases per million capita on statins.
Statins can increase the level of enzymes in the liver and if this happens you may need to change the drug you are on. Your GP may request a liver enzyme test before treatment as a base line to compare to if you have any further symptoms.
When to call the GP
If you get extreme fatigue or weakness
Loss of appetite
Pain in your upper Abdomen
Dark coloured urine
Yellow skin or eyes
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.
The increase generally occurs when blood sugar levels are already higher than normal and fall in the prediabetes or diabetes range when you begin taking a statin.
Statins prevent heart attacks in people with diabetes, so the relevance of the mild increase in sugar values with statins observed in some people is unclear. The benefit of taking statins likely outweighs the small risk to have the blood sugar level go up. 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.
Who is most at Risk of Developing Side Effects?
There is a greater risk if:
· You are taking other medications to lower your cholesterol
· With certain tablets
· If you are female
· You are light
· Aged over 80
· You already have kidney or liver disease
· You drink too much alcohol
· You suffer from hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS)
Interactions - Drugs and Food
Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system.
Try and avoid grapefruit
Drugs that may interact with statins and increase your risk of side effects include:
· Amiodarone (Cordarone, Pacerone), a medication for irregular heart rhythms
· Gemfibrozil (Lopid), another variety of cholesterol drug
· HIV treatments called protease inhibitors such as saquinavir (Invirase) and ritonavir (Norvir)
· Some antibiotic and antifungal medications, such as clarithromycin and itraconazole (Onmel, Sporanox)
· Some immunosuppressant medications, such as cyclosporine (Gengraf, Neoral, Sandimmune)
There are many drugs that may interact with statins, so be sure your doctor is aware of all the medicines you take when being prescribed with statins.
What should I do if I have statin side effects?
To relieve side effects believed to be caused by statins, 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 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.
· 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. Another option is to take the medication every other day, especially if you take a statin that stays in the blood for several days. Talk to your doctor to determine if this is appropriate for you.
· Take it easy when exercising- Unaccustomed vigorous exercise might increase the risk of muscle injury. It’s best to make changes in your exercise routine more gradually. Exercise causes muscle pain too, so it is sometimes difficult to know if the pain comes from the statin or the exercise in someone who just started an exercise program.
· Consider other cholesterol-lowering medications- Although statins are the most effective oral medications for lowering your cholesterol, other types of drugs also are available. Sometimes, taking a combination of cholesterol drugs can provide the same result with lower doses of statins.
· Try coenzyme Q10 supplements- Coenzyme Q10 supplements may help prevent statin side effects in some people, though more studies are needed to determine any benefits of taking it. Talk to your doctor first to make sure the supplement won’t interact with any of your other medications.
Weigh the risks and benefits
Although side effects believed to be caused by statins 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.
If you have read about the potential side effects of statins, you may be more likely to blame your symptoms on the medication, whether or not they’re truly caused by the drug.
Even if your side effects are frustrating, don’t stop taking your statin medication for any 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
If I was going to get muscle pain when would it start?
You will probably notice it as soon as you start taking the medication.
If you can bear the discomfort it is a good idea to keep taking the statinfor at least 2 to 3 weeks to see if the side effect may go away once you get used to the medication.
Statins are usually used in combination with lifestyle measures, such as:
· eating a healthy diet low in saturated fat
· moderating your alcohol consumption
extracts from NHS site and Mayo clinic