3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, commonly referred to as statins
Some common statins include: AtorvastatinFluvastatinLovastatinPravastatinSimvastatinRosuvastatin
Conditions that may require statins: High cholesterol
What statins do:
Help certain people decrease their risk of cardiovascular disease (CVD),
, and death if used along with diet and exercise
Lower total cholesterolLower LDL-cholesterol (bad cholesterol)Raise HDL-cholesterol (good cholesterol)Lower triglyceridesLower C-reactive protein levels—a marker of inflammation, which is thought to increase risk of CVD
Although some people can attain their goals with diet and exercise alone, statins may be prescribed based on your overall risk of having a
or stroke in the next 10 years. Communication is an important aspect of your care. If you have questions or concerns about taking medications when your cholesterol numbers are on target, talk to your doctor about them.
Statins block an enzyme in the liver (HMG-CoA reductase) that produces cholesterol. They are particularly effective at reducing LDL-cholesterol.
It is important that your doctor check your progress. Regular visits will allow for dosage adjustments and to help monitor for any side effects.
Statins should not be taken during pregnancy. Cholesterol production is essential for normal fetal development. Statins decrease cholesterol production and therefore may cause birth defects. Women who are able to become pregnant should use birth control while taking a statin drug. Tell your doctor if you think you might be pregnant or you are considering becoming pregnant. Also tell your doctor if you are breastfeeding, as statins may cause problems for a nursing baby.
If you are overweight or
, losing weight may help decrease the need for or amount of medication. Check with your doctor about this.
Tell your doctor about all the medications you take. Some medications should not be taken with statins, while others may require a different dosage level. Examples of these include: Antifungals, such as fluconazole,
or ketoconazoleImmunosuppresants, such as cyclosporineDigoxin—some statins may increase blood levels of digoxin, increasing the risk of side effectsMacrolide antibiotics, such as erythromycin or clarithromycinFibric acid derivatives, such as gemfibrozilNiacin
or nicotinic acid—use of this type of medication with a statin may increase the risk of developing muscle problemsOral contraceptives/birth control pills—some statin drugs may increase the blood levels of the hormones in birth control pills, increasing the risk of side effectsAntidepressants, such as nefazodone
Talk to your doctor about the medications that you take and whether there could be an interaction with the statin.
The presence of other medical problems may affect the use of statins. Tell your doctor if you have any other medical problems, especially: Alcohol abuseEpilepsy
that is not well controlled
Electrolyte or metabolic enzyme deficiencies or disordersInfectionLiver disease or persistently high levels of liver enzymes—statin drugs may make liver problems worseLow blood pressureOrgan transplant with therapy to prevent transplant rejectionKidney failure
Recent major surgery or
, which may increase the risk of problems that may lead to kidney failure
Impending surgery, including dental surgery or emergency treatment—be sure to tell the doctor or dentist treating you that you are taking a statin drug
Excessive amounts of alcohol combined with statin drugs can have bad affects on the liver. Moderation in alcohol consumption is generally defined as one drink per day for women and two drinks per day for men.
Grapefruit juice appears to interfere with the metabolism of most statin drugs. It is best to avoid it during treatment.
Do not stop taking your statin medication without first checking with your doctor. When you stop, your cholesterol levels may increase, and your doctor may want to use other ways to keep cholesterol levels within a more desirable range.
Lovastatin works better when it is taken with food. If you are taking lovastatin once a day, take it with the evening meal. If you are taking more than one dose a day, take each dose with a meal or snack.
If you are taking another kind of statin, ask the pharmacist if you need to take it with food.
If you miss a dose of your statin drug, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Avoid double doses.
Statin drugs are generally considered safe and few people need to discontinue them due to adverse effects. The side effects listed here have been reported for at least one of the statins, not necessarily all of them. However, since many of the effects of statins are similar, it is possible that these side affects may occur with any one of these medications, although they may be more common with some than with others.
The most significant adverse effects, though rare, involve the liver (elevated liver enzymes) and the muscles (different conditions called myopathy and
Other potential adverse effects include changes in mental status, such as memory loss and confusion, and increased blood glucose levels.
Go to any follow-up appointments recommended by your doctor. Statins and their side effects can be monitored. If needed, your dosage or medication may be changed.
Common side effects include: ConstipationDiarrheaFlatulence (gas)
heartburnAbdominal painNauseaLightheadednessSexual dysfunction
Talk to your doctor if any side effects occur frequently and/or become bothersome.
Check with your doctor as soon as possible if any of the following side effects occur: Muscle aches, cramps, stiffness, tenderness, or weakness, especially if accompanied by unusual tiredness and/or feverMemory loss and/or confusionSymptoms of high glucose levels, such as increased urination, extreme thirst, hunger, or fatigueBrown urineAnkle, feet, or leg swellingChest painFeverSkin rashConstant or worsening stomach painUnusual tiredness or weakness
Yellowing of the eyes or skin—
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1/30/2009 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients.
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http://www.ebscohost.com/dynamed: FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm. Updated March 2, 2012. Accessed April 23, 2014.
Last reviewed May 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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