Why Statins Might Cause Muscle Pain

Statins are a group of cholesterol-lowering medications that work by blocking a key protein, HMG-CoA reductase, which is responsible for making cholesterol in the liver. Millions of Americans take statins because they effectively target all aspects of your lipid profile by lowering LDL cholesterol and triglycerides while raising HDL cholesterol, while also reducing the chance of stroke and heart attack.

However, as with most medications, there are potential side effects users should be aware of. Muscle pain is the most common side effect of statins. Others include liver damage, digestive problems, increased blood sugar, memory loss and confusion.

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

Symptoms

Statin-related muscle pain can vary in symptoms 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 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 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. release of muscle fiber contents into the blood.

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, 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.

Risk Factors

About 5 to 10% of patients taking statins experience statin-associated muscle symptoms (SAMS) and mild myalgia, or muscle pain. Your risk of muscle damage while taking statins depends on a variety of factors, including:

  • Being over 80
  • Having a smaller body frame
  • Drinking alcohol excessively
  • Being female
  • Having certain conditions like hypothyroidism
  • Suffering prior muscle problems

Additionally, 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 to ease these symptoms. People who have the muscle disease amyotrophic lateral sclerosis (ALS) are also at higher risk for muscle pain while taking statins.

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

Causes

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 (muscle wasting), 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 humans taking Mevacor (lovastatin) have higher levels of atrogin-1 than those not taking the drug, and 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.

Diagnosis and treatment

If you experience muscle problems after beginning to take statins, your doctor will usually have you stop treatment until the problem resolves. 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, including muscle pain. 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.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Salami JA, Warraich H, Valero-elizondo J, et al. National trends in statin use and expenditures in the U.S. adult population From 2002 to 2013: Insights from the Medical Expenditure Panel Survey. JAMA Cardiol. 2017;2(1):56-65. doi:10.1001/jamacardio.2016.4700

  2. Thompson PD, Panza G, Zaleski A, Taylor B. Statin-associated side effects. J Am Coll Cardiol. 2016;67(20):2395-2410. doi:10.1016/j.jacc.2016.02.071

  3. Rosenson RS, Baker SK, Jacobson TA, et al. An assessment by the statin muscle safety task force: 2014 updateJ Clin Lipidol 2014; 8:S58. doi:10.1016/j.jacl.2014.03.004

  4. MedlinePlus. Creatine Kinase.

  5. MedlinePlus. Rhabdomyolysis. Updated August 1, 2017.

  6. Mammen AL. Statin-associated autoimmune myopathy. N Engl J Med. 2016;374(7):664-9. doi:10.1056/NEJMra1515161

  7. Ward NC, Watts GF, Eckel RH. Statin toxicity. Circ Res. 2019;124(2):328-350. doi:10.1161/CIRCRESAHA.118.312782

  8. Gupta A, Thompson PD. The relationship of vitamin D deficiency to statin myopathy. Atherosclerosis. 2011;215(1):23-9. doi:10.1016/j.atherosclerosis.2010.11.039

  9. Golomb BA, Verden A, Messner AK, Koslik HJ, Hoffman KB. Amyotrophic lateral sclerosis associated with statin use: A disproportionality analysis of the FDA's adverse event reporting system. Drug Saf. 2018;41(4):403-413. doi:10.1007/s40264-017-0620-4

  10. Lee D, Goldberg A. Atrogin1/MAFbx: what atrophy, hypertrophy, and cardiac failure have in common. Circ Res. 2011;109(2):123-6. doi:10.1161/CIRCRESAHA.111.248872

  11. Di stasi SL, Macleod TD, Winters JD, Binder-macleod SA. Effects of statins on skeletal muscle: a perspective for physical therapists. Phys Ther. 2010;90(10):1530-42. doi:10.2522/ptj.20090251

  12. Harvard Medical School. Harvard Health Publishing. Managing statin muscle pain. Updated August 9, 2019.