What is Statin Intolerance

Statin intolerance is the inability to take a certain type of cholesterol-lowering medicine (statin) because of unwanted side effects, such as muscle pain. Statins may be prescribed to improve cholesterol levels and lower the risk for heart attack, heart disease, and stroke. People with statin intolerance may experience muscle pain and cramps (myalgia) that go away when the statin is stopped.

What are the causes?

The cause of this condition is not known.

What increases the risk?

You may be at higher risk for statin intolerance if you:

• Take more than one type of cholesterol-lowering medicine at a time.
• Need a higher than normal dosage of a statin.
• Have a history of high CK (creatine kinase) in the blood. CK is an enzyme that is released when muscle tissue is damaged.
• Are a woman.
• Have a body size that is smaller than normal.
• Are age 70 or older.
• Drink a lot of alcohol.
• Are of Asian descent.
• Have kidney, liver, or muscle disease.
• Have a low level of hormones that control how your body uses energy (hypothyroidism).
• Take certain medicines, including:
  • Certain medicines for mental illness (antipsychotics).
  • Some types of antibiotics.
  • Certain medicines used for blood pressure or heart disease.
  • Medicines that reduce the activity of the body’s disease-fighting system (immunosuppressants).
  • Medicines to treat hepatitis C and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome).
• Follow an intense exercise program.
• Drink a lot of grapefruit juice.
• Have a lack of vitamin D (deficiency).

What are the signs or symptoms?

Signs and symptoms of statin intolerance include:

• General muscle aches (myalgia). This may feel similar to muscle aches that are caused by the flu.
• Muscle pain, tenderness, cramps, or weakness (myositis).
• Severe muscle pain, weakness, and raised blood CK levels (rhabdomyolysis).

Symptoms usually go away when the statin is stopped.

Rarely, liver damage can also occur, which can cause:

• Loss of appetite.
• Pain in the upper right abdomen.
• Yellowing of the skin or the white parts of the eyes (jaundice).

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam. You may also have blood tests.

How is this treated?

Your health care provider may have you stop taking the statin for a short time to see if your symptoms go away. Then your provider may restart your statin, or:

• Change you to a different statin.
• Lower the dosage of your statin.
• Have you take your statin less often.
• Change you to another type of cholesterol-lowering medicine.
• Stop or change any medicines that might be interfering with your statin.
• Limit how much grapefruit juice you drink.
• Recommend stopping intense exercise.

Follow these instructions at home:

Medicines

• Take your statin medicine as told by your health care provider. Do not stop taking the statin unless your health care provider tells you to stop.
• Take other over-the-counter and prescription medicines only as told by your health care provider.
• Check with your health care provider before taking any new medicines. Certain medicines can increase your risk for statin intolerance.

Lifestyle

• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

General instructions

• Have blood tests to check CK levels or liver enzymes as told by your health care provider.
• Exercise as directed. Ask your health care provider what exercises are best for you. Do not start a new exercise program before talking about it with your health care provider.
• Follow instructions from your health care provider about eating or drinking restrictions. Your health care provider may recommend:
  • Limiting the amount of grapefruit juice you drink, or not drinking it at all.
  • Eating a diet that is low in saturated fats and high in fiber.
• Maintain a healthy weight with diet and exercise.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have any symptoms of statin intolerance.

Summary

• Statins are important medicines for improving your cholesterol, which may reduce your risk for heart attack and stroke.
• Some people are not able to continue taking a particular statin because of muscle problems (myalgia) or other side effects.
• Myalgia is the most common symptom of statin intolerance. Often, the muscle pain and cramps from myalgia go away when the statin is stopped.
• Although rare, liver damage can occur as a result of statin intolerance. You should have routine blood tests to check your liver enzymes.
• In most cases, statin intolerance can be managed and you can continue to take a cholesterol-lowering medicine.