Cholesterol-lowering drugs – especially statins – are among the most frequently prescribed drugs in the world. They are prescribed to inhibit the liver’s own production of cholesterol and have a powerful, well-documented effect: They can lower harmful LDL cholesterol by 25 to 45 percent and slow the development of atherosclerosis.
Although statins are generally well tolerated by the vast majority of people, as with all other medications, side effects can occur.
Common side effects of statins
Most side effects are mild and temporary. The most common include:
Stomach and intestinal discomfort: Nausea, stomach pain, bloating or changing stools.
Muscle discomfort: Mild muscle pain, stiffness or cramps.
General symptoms: Fatigue, dizziness and mild headache.
When should you avoid statins?
You should not usually take statins if you have active liver disease, severely reduced liver function, or if you are pregnant or breastfeeding.
Statins with the fewest muscle complaints
There are various preparations within the statin group. Research and clinical guidelines (including from Huisarts en Wetenschap) indicate that drugs such as pravastatin and fluvastatin often cause the least muscle pain compared to stronger statins such as simvastatin or atorvastatin.
Alternatives to statins
If statins cause unacceptable side effects or if they do not If the cholesterol level is lowered sufficiently, there are other treatment options:
Cholesterol absorption inhibitors (e.g. ezetimibe)
Fibrates and bile acid sequestrants
PCSK9 inhibitors (newer, injectable treatment for special cases)
Never change your medication or dosage without first consulting your doctor.
Serious but rare side effects
In very rare cases, statins can cause a serious breakdown of muscle tissue (called rhabdomyolysis). This can lead to the release of protein into the blood, which can eventually lead to kidney damage.
Always seek medical attention if you experience unexplained, severe muscle pain combined with dark urine or fever.
Watch out for interactions with other medications
Side effects can be enhanced if statins are combined with certain other types of medications. This includes:
Certain types of antibiotics and antifungals
Specific heart medications and blood pressure medications
Antiviral medication
Grapefruit juice and statins: A dangerous combination!
If you are taking cholesterol-lowering medications (especially simvastatin and atorvastatin), you should avoid drinking grapefruit juice.
Grapefruit contains substances (furanocoumarins) that inhibit the enzymes in the liver and intestines that normally break down the medication. This means that the medication is broken down more slowly, leading to a higher concentration of the drug in the blood. This significantly increases the risk of serious side effects and muscle damage.
What do you need? What to do if you experience side effects?
Do not stop treatment on your own: This may increase the risk of blood clots.
Talk to your doctor: Most often, a simple dose adjustment, a switch to a different type of statin, or a switch to ezetimibe can eliminate the side effects completely.
Supplement with lifestyle: A healthy diet, exercise and quitting smoking support cholesterol lowering naturally.
