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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:
Generic Name Brand Name
atorvastatin Lipitor
fluvastatin Lescol
lovastatin Mevacor
pravastatin Pravachol
simvastatin Zocor
rosuvastatin Crestor

What They Are Prescribed For

Conditions that may require statins:
What statins do:
  • Help certain people decrease their risk of cardiovascular disease, 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)
Before prescribing a statin, your doctor will suggest that you try to reduce your risk of heart attack and stroke by diet and exercise. This typically involves reducing your intake of total fat, saturated fat, and, if you are overweight, total calories. Some people are able to lower their cholesterol and decrease their risks of heart attack and stroke by these changes alone. Medicine is prescribed only when additional help is needed. It is most effective in combination with dietary changes and regular exercise.

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 Medicines

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 medicine. Check with your doctor about this.

Manage Your Medications

Tell your doctor about all the medicines you take. Some medicines should not be taken with statins, while others may require a different dosage level. Examples of these include:
  • Antifungals—fluconazole (eg, Diflucan), itraconazole (eg, Sporanox), ketoconazole (eg, Nizoral)
  • Cyclosporine (eg, Neoral)
  • Digoxin (eg, Lanoxin)—Some statins may increase blood levels of digoxin, increasing the risk of side effects.
  • Macrolide antibiotics—erythromycin, clarithromycin
  • Fibric acid derivatives—gemfibrozil (eg, Lopid)
  • Niacin or nicotinic acid—Use of this type of medicine 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.
  • Nefazodone (eg, Serzone)
Talk to your doctor about the medicines 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 medicine 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 patients 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 medicines, 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 (eg, memory loss and confusion) and increased blood sugar levels.
Following up regularly with your doctor will allow him or her to detect these problems through your medical history and blood tests.

Common Side Effects

Common side effects include:
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 blood sugar (eg, increased urination, extreme thirst, hunger, fatigue)
  • Brown urine
  • Ankle, feet, or leg swelling
  • Chest pain
  • Fever
  • Skin rash
  • Constant or worsening stomach pain
  • Unusual tiredness or weakness
  • Jaundice (yellowing of the eyes or skin)
Check with your doctor if any of the following side effects occur frequently and/or become bothersome:
  • Constipation
  • Diarrhea
  • Dizziness
  • Gas
  • Headache
  • Heartburn
  • Indigestion
  • Nausea
  • Stomach pain
  • Decreased sexual ability
  • Trouble sleeping

RESOURCES

Family Doctor.org http://familydoctor.org/

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

CANADIAN RESOURCES

Canadian Medical Association http://www.cma.ca/

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

References

Atorvastatin. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated June 28, 2010. Accessed March 23, 2011.

Controlling cholesterol with statins. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048496.htm. Updated February 22, 2010. Accessed June 25, 2012.

Statins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 18, 2012. Accessed June 25, 2012.

Wood D. Type 2 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 20, 2011. Accessed March 6, 2012.

1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : 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/what.php: 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. Published February 28, 2012. Accessed March 6, 2012.

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