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Do statins cause muscle pain?
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Can statins cause liver damage?
It's rare, but statins can sometimes cause muscle inflammation (swelling) and damage. Speak to your doctor if you have muscle pain, tenderness or weakness that cannot be explained – for example, pain that is not caused by physical work.
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An international team of BHF-funded researchers may have discovered why a small number of people experience muscle pain after taking statins. The research could help doctors prevent a known side effect of statins and ensure people are able to reap the benefits of the life-saving drugs.
May 27, 2023 · Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis (rab-doe-my-OL-ih-sis). Rhabdomyolysis can cause extreme muscle pain, liver damage, kidney failure and death. The risk of very serious side effects is extremely low.
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- Overview
- What causes statin muscle pain?
- What does it feel like?
- Risk factors for statin side effects
- Will the muscle pain go away?
- How to reduce pain
- Statin alternatives
- Complications
- When to contact a doctor
- Summary
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Statins are a type of drug that lowers cholesterol levels in the blood. Usually, people who take statins tolerate them well. However, some may experience side effects, such as muscle pain.
Researchers estimate that approximately 7–29% of people who take statins experience statin-associated muscle symptoms, known collectively as SAMS.
Cell damage
In a 2019 study, researchers looked at the impact of statins on muscles in both humans and rats over the course of 4 weeks. They observed that in human skeletal muscle, statin treatment disrupted the release of calcium from muscle cells. Normally, muscles release some calcium upon stimulation. If this process becomes unstable, it can trigger tissue damage and cell death. This mechanism may explain the cause of SAMS. However, when the scientists applied electric stimulation to muscles, it did not seem to affect the muscles’ ability to move. Similarly, statins did not have any influence on muscle function or strength in rats, possibly because exercise prevented the statins from causing muscle damage. The researchers suggest that statin muscle pain may affect individuals who are susceptible to it but that exercise may reverse the impact.
‘Nocebo’ effect
Authors of a 2021 study carried out a series of randomized, placebo-controlled trials on older adults who had previously experienced muscle pain while taking statins. One group took 20 milligrams of atorvastatin per day for 2 months, while another took a placebo. The researchers found little difference between rates of muscle pain in either group. They suggest that the pain may be due to other factors, such as age-related conditions, as most people in the study were 65–79 years old. Another factor could be the “nocebo” effect, which occurs when peoples’ negative expectations of a drug cause them to experience symptoms. As many people are aware that statins may cause muscle pain before they take them, it is possible this could influence their perception of symptoms. However, it is important to note that this study only tested one type of statin at a low dose on one age group. Scientists will need to carry out further studies to better understand what causes statin muscle pain.
Muscle pain caused by statins can be mild, moderate, or severe. People with SAMS may experience:
•muscle weakness
•stiffness
•muscle pain
•inflammation or tenderness
People with SAMS typically experience pain in the calves and thighs. However, SAMS can affect all the skeletal muscles of the body.
A number of factors may put a person at higher risk of developing SAMS, including:
•higher statin dosages
•lower muscle mass, which can be more common in older adults, people with physical disabilities, females, and people with a lower body mass index
•hypothyroidism
•alcohol consumption
•vitamin D deficiency, which may be more common in older adults, people who spend a lot of time indoors, and people with darker skin
Generally, symptoms of SAMS resolve on their own if a person stops taking statins.
However, if they do so without medical supervision, they may develop high levels of cholesterol. This in turn increases risk of serious conditions, including heart disease, heart attack, and stroke.
Instead of stopping statins entirely, doctors will first:
•remove any factors that could be contributing to muscle pain
•try alternative statins
•try different dosages
Scientists are still learning about what can help with statin muscle pain. However, some research suggests that the following may prove helpful:
•Moderate exercise: A 2019 study concludes that in rats, moderate exercise may reverse the physiological changes that could lead to statin muscle pain.
•Vitamin D: Increasing vitamin D intake via safe sun exposure, food, or supplements may help reduce muscle pain in general. Further studies are necessary to verify the benefits of vitamin D for a person with SAMS.
•Coenzyme Q10 (CoQ10): Research from 2018 suggests that CoQ10 supplements may help manage SAMS. However, a 2020 review found that CoQ10 supplements did not have a beneficial effect on SAMS.
People can also avoid consuming things that may contribute to the pain, such as alcohol, grapefruit, starfruit, and pomegranate.
According to the 2020 review, 90% of people experiencing SAMS who receive medical help and reassurance go on to be able to tolerate statins.
A person who cannot tolerate statins can consult their doctor about trying a different drug. The doctor may recommend one of the following:
•ezetimibe, a drug that reduces cholesterol absorption
•fibrates, which lower triglyceride levels and increase high-density lipoprotein (HDL) cholesterol
•nicotinic acid, which raises HDL cholesterol
•bile acid sequestrants, a group of drugs used to treat high cholesterol and raise HDL cholesterol
•proprotein convertase subtilisin/kexin type 9 inhibitors, which lower low-density lipoprotein cholesterol
Immune-mediated necrotizing myopathy
Immune-mediated necrotizing myopathy (IMNM) is a rare condition that causes cells to die. According to a 2018 review, it affects two to three statin users per 100,000. There is no known cure, although treatments are available to manage symptoms. IMNM symptoms include: •weakness in the forearm, hips, thigh, shoulder, neck, and back muscles •difficulty climbing stairs or getting out of a chair •difficulty raising arms above the head •falling •difficulty getting up after a fall •tiredness
Rhabdomyolysis
Rhabdomyolysis occurs due to rapid muscle tissue death. It is a serious condition that, on average, affects less than one statin user per 100,000. The kidneys remove waste produced by damaged muscle cells. If there is too much waste, kidney failure may occur. Symptoms of rhabdomyolysis include: •muscle pain, especially in the shoulders, lower back, or thighs •swelling of the muscles •muscle weakness •dark red or tea-colored urine •decreased urine production •abdominal pain •nausea •vomiting •fever •fast heart beat •confusion •loss of consciousness •dehydration In rare cases, rhabdomyolysis can be fatal. If a person suspects they have rhabdomyolysis, they should seek immediate medical attention.
A person experiencing unexplained muscle pain while taking statins should speak with their doctor. The doctor can help determine whether statins are causing their muscle pain, and discuss treatment options.
A person who experiences muscle pain alongside any other concerning symptoms should seek guidance from a doctor immediately.
Although people usually tolerate statins well, some people experience muscle pain or weakness.
The exact cause of SAMS is unknown. However, there are many risk factors that may contribute to it, such as having a lower muscle mass or a vitamin D deficiency.
Statin muscle pain, or SAMS, is a common side effect of cholesterol-lowering drugs. Learn about the possible causes, symptoms, risk factors, and ways to ease it, as well as when to contact a doctor.
Jul 18, 2023 · Statin-related muscle pain, if it happens at all, usually happens within the first few months after you start the drug or raise the dose. You may feel a constant soreness or weakness in...
- Keri Wiginton
Aug 29, 2022 · Statins are not the cause of muscle pain in over 90 per cent of people who experience symptoms, according to research we have funded presented today at the European Society of Cardiology Congress in Barcelona and published in The Lancet.
Aug 29, 2022 · People on cholesterol-lowering statins can be reassured that it is uncommon for the tablets to cause muscle pain, say the authors of a large study. The pills can protect against heart attacks...
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