An Overview of Muscle Pain in Statin Users

Statins are a group of cholesterol-lowering medications. While greatly beneficial to many people working to manage hyperlipidemia, like all drugs, statins come with the risk of side effects. So-called statin-associated muscle symptoms (SAMS)—including myalgia (generalized muscle pain) and myopathy (diseases that cause muscle weakness)—are notable ones.

Muscle pain associated with statins may be mild and uncomfortable or significant enough to impact daily life. In rare cases, the impact of these drugs on the muscles can be serious.

Symptoms

SAMS can vary in frequency and severity. The following are the three most common forms of statin-related muscle pain:

  • Myalgia: This type of muscle pain usually feels like mild soreness in the shoulders, arms, hips or thighs. Myalgia also often comes with mild feelings of weakness.
  • Myositis: Myositis, a type of myopathy, causes muscle pain and inflammation, as well as an elevation in CK (a muscle enzyme) levels in the blood. The presence of CK in the blood is an indicator of muscle damage.
  • Rhabdomyolysis: While fortunately very rare, this severe type of myopathy is a life-threatening condition characterized by the breakdown of muscle tissue that causes muscle fiber contents to be released into the blood, potentially causing kidney damage.

Muscle problems related to statin therapy usually begin within a few weeks to a few months after beginning treatment. While statin-related myalgia, myositis, and rhabdomyolysis will resolve once you stop taking statins, rhabdomyolysis may result in irreversible muscle damage.

Additionally, a 2016 study showed statin-associated autoimmune myopathies are also a side effect of statins. This serious muscle wasting condition is rare and occurs in a fraction of patients.

Causes

While there are several theories as to why statins may cause muscle pain, none have been confirmed.

Research has shown that the gene atrogin-1 may be the source of muscle pain in those taking statins. This gene turns on at the beginning stages of the breakdown of muscle, which is associated with illnesses such as cancer, sepsis, and AIDS. (When the atrogin-1 gene is not active, muscle wasting does not occur.)

Research has also shown that people taking Mevacor (lovastatin) have higher levels of atrogin-1 than those not taking the drug. When the drug is removed from the cells, it does not appear to cause muscle damage. In the future, this may allow your healthcare professional to identify if you are at risk for statin-related muscle pain. Additionally, scientists may be able to manipulate this gene, or others involved, to prevent muscle damage caused by statins.

Another theory is that statins can potentially interfere with the production of CoQ10, a coenzyme in the muscles. CoQ10 assists the muscles in using the energy they need to function properly. Research has suggested that taking CoQ10 supplements might lower your chances of experiencing statin-related myopathy, but available data is still not sufficient enough to back this up.

High-dose simvastatin (brand name Zocor) appears to present a higher risk for muscle pain than other statin drugs. The risk appears to be significantly lower with Lescol (fluvastatin), Pravachol (pravastatin) and Crestor (rosuvastatin). As such, it's recommended that the dosage of simvastatin be limited to 40 milligrams (mg) per day, which can reduce the risk of muscle problems.

Risk Factors

About 5% to 10% of patients taking statins experience SAMS or mild muscle pain. Your risk of experiencing SAMS while taking statins is increased if you:

  • Are older than 80
  • Are female
  • Have a smaller body frame
  • Drink alcohol excessively
  • Have certain conditions like hypothyroidism
  • Have had prior muscle problems
  • Consume large amounts of grapefruit or cranberry juice

Statin-related muscle problems are more likely to occur in people who exercise vigorously, especially if they begin to do so at a rapid rate rather than slowly building up intensity.

It is also more common in people taking a variety of other medications, including Lopid (gemfibrozil), as well as steroids, cyclosporine, or niacin.

Furthermore, studies have also shown that people with vitamin D deficiency also tend to experience muscle problems with statins more frequently than others. Some experts have reported that administering vitamin D to these people helps ease these symptoms.

People who have the muscle disease amyotrophic lateral sclerosis (ALS) are also at higher risk for muscle pain while taking statins.

Diagnosis and Treatment

Millions of Americans take statins because they effectively target all aspects of one's lipid profile by lowering low-density lipoprotein (LDL) cholesterol and triglycerides while raising high-density lipoprotein (HDL) cholesterol. They also reduce the chance of stroke and heart attack.

Because of these benefits, the decision to stop taking statins because of related muscle pain is carefully considered.

If you have started statins and experience muscle pain, see your doctor. While it may be likely that it is indeed the drug that is causing your discomfort, they will consider the possibility of other causes as well.

Your doctor will likely also test your blood for increased creatine kinase (CK) levels—an indicator of rhabdomyolysis. If detected, statins will be stopped right away.

However, if your only symptoms are pain and/or a minor increase in CK blood levels, your doctor may decide that the benefits of continuing with statin therapy outweigh the cons. They may suggest stopping treatment only briefly until the problem resolves, or not at all.

Sometimes switching to a different type of statin can resolve muscle-related pain and side effects, so your doctor may recommend this if you're in search of relief.

While there aren't proven pain relief mechanisms for statin-related muscle pain, you may also find that gentle exercise and stretching may help.

A Word From Verywell

While statins are proven to help reduce cholesterol, they come with a variety of risks and side effects. Besides muscle pain, these can include liver damage, digestive problems, increased blood sugar, memory loss and confusion.

As with any drug, you should bring up any concerns you have with your doctor to ensure that this is still the right treatment plan for you, and you should never stop taking a prescribed medication without your doctor's OK.

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