What you should know about controlling cholesterol with statins
:format(webp))
The bottom line
Statins lower cholesterol and decrease risk of stroke and heart attack. Side effects include stomach upset, fatigue, headaches, and muscle pain. Taking too much can increase risk of severe muscle damage with kidney failure, liver damage, and type 2 diabetes. Interactions with food (such as grapefruit) and drugs can increase statin levels resulting in greater likelihood of side effects.
Prevention tips
Keep statins up, away, and out of reach of children.
Take daily as prescribed.
Avoid grapefruit and grapefruit juice if you take simvastatin, atorvastatin, or lovastatin.
Check with your doctor or pharmacist before starting any new medication.
Avoid drinking too much alcohol.
Maintain a healthy lifestyle including eating healthy foods and exercising.
If you are experiencing side effects, ask your doctor about prescribing a different statin.
This really happened
A 72-year-old man was admitted to the hospital with thigh weakness, achiness, and dark urine for 1 week. He had a past medical history of diabetes, hyperlipidemia, hypertension, and mild azotemia (buildup of nitrogen in blood because of kidney insufficiency), all treated with medications.
Approximately 2 months earlier he had coronary artery bypass surgery. A few days after surgery he was started on amiodarone and 5 weeks later simvastatin. On this admission, his creatine kinase, serum myoglobin and urine myoglobin were elevated. These all indicated muscle damage. In addition, blood urea nitrogen (BUN) and serum creatinine were elevated indicating abnormal kidney function. Liver enzymes were also elevated. Simvastatin and amiodarone were discontinued. He was hydrated with intravenous fluids and his urine was alkalinized.
Thirteen days later, all laboratory findings were markedly improved. Three months later most laboratory values were normal. The rhabdomyolysis, kidney failure, and possible liver injury were assessed as probably related to an amiodarone-simvastatin interaction.
Poisoned? Get expert help.
Don't guess what you should do. Get accurate answers online or by phone. Both ways are free and confidential.
OR
call 1-800-222-1222
What are statins?
Statins are drugs that lower cholesterol and decrease your risk of stroke and heart attack. The liver enzyme HMG-CoA reductase makes cholesterol. Low-density lipoprotein (LDL) is the bad lipoprotein that carries cholesterol in your blood and deposits it in the walls of your arteries. This leads to plaque formation which blocks blood flow and increases risk of heart attack and stroke.
Statins block the enzyme HMG-CoA reductase, which results in your liver making less cholesterol. When your liver makes less cholesterol, LDL is pulled out of the blood. As a result, statins cause both cholesterol and LDL to be lower.
What to do if you take too much of a statin
If you accidentally take an extra dose, you do not need to do anything. If you take a large dose or take too much chronically, you should seek medical attention.
Get expert help
If someone swallows a large amount of a statin or if you have questions about using statins safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
Side effects of statins
Side effects include nausea, diarrhea or constipation, and gas. Other side effects include fatigue, headaches, muscle aches, and tenderness. Rarely, liver enzymes increase or severe muscle breakdown (rhabdomyolysis) occurs leading to kidney damage.
Common statins and their uses
Common statins are atorvastatin (Lipitor), lovastatin (Altoprev), rosuvastatin (Crestor), and simvastatin (Zocor). All are also available in generic form.
Every statin blocks the liver enzyme HMG-CoA reductase to reduce cholesterol and LDL, and reduces vascular inflammation. Statins are considered low, moderate, and high intensity based on how well they lower cholesterol and LDL. For example, atorvastatin and rosuvastatin are high-intensity statins since they cause greater decreases in cholesterol and LDL. These are good choices for people with cardiovascular disease. Another important difference is the potential for drug and food interactions (see below).
Do statins cause muscle pain?
Yes, statins can cause muscle pain, tenderness, and weakness that involve large muscles such as hips, thighs, and calves. It usually starts soon after starting the statin or increasing the dose. It is known as statin-associated muscle symptoms (SAMS). The actual risk of muscle pain is low, about 5%.
What happens if you take too much of a statin?
Taking too much of a statin can increase your risk of toxicity, especially muscle pain and possibly severe muscle damage which releases proteins that cause kidney failure. Other possible toxicity includes stomach upset, liver damage, and increased risk of developing type 2 diabetes.
Do statins interact with other medicines or foods?
Some statins (but not all) interact with other medicines or foods. For example, grapefruit interacts with simvastatin, atorvastatin, and lovastatin by blocking an enzyme in the digestive system that breaks down these drugs. As a result, more drug is absorbed into the blood. Red yeast rice contains a natural statin, so taking it alongside a prescription statin adds to your total statin dose. Both interactions increase the risk of side effects.
Drugs that raise statin levels in your body include some antibiotics and antifungals (clarithromycin, erythromycin, itraconazole), cyclosporine, HIV protease inhibitors, and some cardiac drugs (amiodarone, diltiazem and verapamil). These medications increase statin levels by blocking the liver enzyme CYP3A4 which breaks down some statins. The highest risk of this interaction is with simvastatin and lovastatin. Atorvastatin is considered moderate risk ( it is still possible for this interaction to occur) and rosuvastatin, pravastatin, and fluvastatin do not have this interaction, so they can be used with these medications.