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Statin Drugs

(HMG-CoA Reductase Inhibitors)

Type of Medication

talking to doctor image 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, commonly referred to as statins

Medications and Their Commonly Used Brand Names

Some common statins include:
  • Atorvastatin
  • Fluvastatin
  • Lovastatin
  • Pravastatin
  • Simvastatin
  • Rosuvastatin

What They Are Prescribed For

Conditions that may require statins:
What statins do:
  • Help certain people decrease their risk of cardiovascular disease (CVD), stroke , and death if used along with diet and exercise
  • Lower total cholesterol
  • Lower LDL-cholesterol (bad cholesterol)
  • Raise HDL-cholesterol (good cholesterol)
  • Lower triglycerides
  • Lower 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 heart attack 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.

How Statins Work

Statins block an enzyme in the liver (HMG-CoA reductase) that produces cholesterol. They are particularly effective at reducing LDL-cholesterol.

Precautions While Using These Medications

See Your Doctor Regularly

It is important that your doctor check your progress. Regular visits will allow for dosage adjustments and to help monitor for any side effects.

Avoid Pregnancy

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.

Control Your Weight

If you are overweight or obese , losing weight may help decrease the need for or amount of medication. Check with your doctor about this.

Manage Your Medications

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, itraconazole, or ketoconazole
  • Immunosuppresants, such as cyclosporine
  • Digoxin—some statins may increase blood levels of digoxin, increasing the risk of side effects
  • Macrolide antibiotics, such as erythromycin or clarithromycin
  • Fibric acid derivatives, such as gemfibrozil
  • Niacin or nicotinic acid—use of this type of medication with a statin may increase the risk of developing muscle problems
  • Oral contraceptives/birth control pills—some statin drugs may increase the blood levels of the hormones in birth control pills, increasing the risk of side effects
  • Antidepressants, such as nefazodone
Talk to your doctor about the medications that you take and whether there could be an interaction with the statin.

Be Cautious With Certain Conditions

The presence of other medical problems may affect the use of statins. Tell your doctor if you have any other medical problems, especially:
  • Alcohol abuse
  • Epilepsy that is not well controlled
  • Electrolyte or metabolic enzyme deficiencies or disorders
  • Infection
  • Liver disease or persistently high levels of liver enzymes—statin drugs may make liver problems worse
  • Low blood pressure
  • Organ transplant with therapy to prevent transplant rejection
  • Kidney failure
  • Recent major surgery or trauma , 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

Avoid Excessive Alcohol

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.

Avoid Grapefruit Juice

Grapefruit juice appears to interfere with the metabolism of most statin drugs. It is best to avoid it during treatment.

Do Not Stop On Your Own

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.

Mind Your Meals with Lovastatin

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.

Missed Dose

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.

Possible Side Effects

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.

Adverse Effects

The most significant adverse effects, though rare, involve the liver (elevated liver enzymes) and the muscles (different conditions called myopathy and rhabdomyolysis ).
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

Common side effects include:
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 fever
  • Memory loss and/or confusion
  • Symptoms of high glucose levels, such as increased urination, extreme thirst, hunger, or fatigue
  • Brown urine
  • Ankle, feet, or leg swelling
  • Chest pain
  • Fever
  • Skin rash
  • Constant or worsening stomach pain
  • Unusual tiredness or weakness
  • Yellowing of the eyes or skin— jaundice

RESOURCES

FamilyDoctor.org—American Academy of Family Physicians http://familydoctor.org

United States Food and Drug Administration http://www.fda.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Heart and Stroke Foundation http://www.heartandstroke.com

References

Controlling cholesterol with statins. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048496.htm. Updated February 22, 2010. Updated December 7, 2013. Accessed April 23, 2014.

Lipid-lowering pharmacotherapy overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 11, 2014. Accessed April 23, 2014.

New statin guidelines: Do they apply to you? Harv Health Lett. 2014;39(4):8.

Statins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 20, 2013. Accessed April 23, 2014.

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. J Am Coll Cardiol. 2008;52:1769-1781.

3/6/2012 DynaMed's Systematic Literature Surveillance 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.

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