Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center
Pomerado Pain Management Center

Posted January 02, 2009

Statins (HMG-CoA Reductase ACE Inhibitors) are used as a cholesterol lowering medication in people with, or at risk of, cardiovascular disease.  It is recommended that a cholesterol lowering diet be tried prior to statin use.  If LDL cholesterol (bad cholesterol) is not reduced through diet and life-style approaches, a statin may be prescribed by your doctor.  In general, statins lower LDL cholesterol (bad cholesterol) and raise HDL cholesterol (good cholesterol).  Examples of statins include the following: 

Rosuvastatin (Crestor)
Lovastatin (Mevacor)
Atorvastatin (Lipitor)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Vytorin – This is a combination of simvastatin and ezetimive.  Ezetimive blocks the absorption of cholesterol in the intestines. 

Statins reduce the risk of heart attack, reduce the risk of stroke and reduce the coronary death rate in people with cardiovascular disease as well as in people at risk of cardiovascular disease.  Like all medications prescribed, there are side effects.  This article will focus on myalgia (muscle pain) and myopathy (muscle weakness) which can occur with statin use.  Other side effects include liver function abnormalities, lupus-like syndrome and peripheral neuropathy. 

The instance of myalgia (muscle pain) ranges from 5% to 10%.  Patients describe myalgias as either muscle pain or muscle cramps.  These symptoms either resolve either on their own or by temporarily lowering or stopping the dose. 

A less common side effect associated with statin use is myopathy (muscle weakness).  Myopathy commonly involves skeletal muscle tissue and patients may present with complaints of generalized muscle weakness of the upper arms and upper legs, muscle pain or fatigue.  This is the most common presentation.  An even less common side effect is rhabdomyolysis which occurs approximately .1% of the time.  Rhabdomyolysis is a condition in which massive muscle injury leads to kidney failure.   

In summary, statins are medically significant due to the fact that they reduce the risk of heart attack, reduce the risk of stroke and reduce the coronary death rate.  Myalgias, which are described as muscle pain or muscle cramps occur approximately 5-10% of the time.  Myopathy (muscle weakness) and rhabdomyolysis occur much less often as do other side effects, including lupus-like syndrome and peripheral neuropathy.

If you develop muscle pain or muscle cramps after beginning a statin, please consult with your doctor.

References:

Molokhia, N; McKeigue, P; Curcin, V, et al.  Statin Induced Myopathy and Myalgia: Time Trend Analysis.  A Comparison of Risk Associated with Statin Class from 1991-2006.  PLoS ONE 2008; 3(6): e2522.

Soininen, K et al.  Muscle Symptoms Associated With Statins: A Series of 20 Patients.  Basic Clin Pharmacol Toxicol.  2006:98 51-54.