Medical Edge Newspaper Column

Statins Sometimes Cause Muscle Aches

July 9, 2007
Dear Mayo Clinic:
I'm taking pravastatin to keep my cholesterol at optimal levels because I had quintuple bypass over 20 years ago. At what point would this medication affect my muscles? And how would I distinguish between the normal aging process and any possible side effect of the pravastatin? -- Naples, Fla.

Answer:
For many patients with elevated cholesterol levels, the doctor will often recommend lifestyle changes instead of a cholesterol-lowering drug. He or she will urge you to try to achieve the desired reduction by following a healthy diet, participating daily in physical activity, maintaining a healthy weight, and avoiding smoking.

Only if such efforts do not go far enough toward lowering cholesterol should drugs be employed. Also, bear in mind that the medication is meant as a complement to, not a substitute for, a healthy lifestyle. A self-indulgent and sedentary way of life would reduce the drug's benefit.

Numerous drugs are available for lowering cholesterol, so one can be chosen to best fit your particular needs. Statins are among the most commonly prescribed. They block an enzyme that controls the rate of cholesterol production in the body, especially in the liver, and they also prompt the liver to remove cholesterol from the blood. These two actions lower total and bad cholesterol and modestly increase good cholesterol levels in the blood. Statins may also help the body reabsorb cholesterol from accumulated deposits in artery walls, potentially reversing coronary artery disease and lowering the risk of stroke and other cholesterol-induced conditions. Options include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor).

Statins tend to have few side effects. Muscle pain, the most common, is experienced by up to nine percent of the patients who take them. Pravasatin itself, at about three percent, is one of the statins least likely to cause muscle pain. If such pain does occur, it will usually appear during the first several weeks or months, and certainly within the first year of therapy. In most cases, the pain is transient, lasting only a few weeks despite continued drug use. This is what may distinguish such pain from similar muscle pain caused by the wear and tear of aging -- the former will likely soon disappear, whereas the latter might be here to stay.

Rarely, statin-related muscle pain will persist, or even worsen. In such cases, the culprit may be myositis, an inflammation of the muscle that causes atrophy of the muscle tissue, much as bone tissue is lost in osteoporosis. Myositis occurs in about one percent of patients. Another, even rarer, complication -- at well below one percent -- is rhabdomyolysis, in which the waste products resulting from muscle-cell breakdown cause kidney damage, potentially leading to kidney failure. The sustained and worsening pain experienced from either of these conditions, as well as accompanying muscle weakness, should serve as alarms to the patient to see a doctor without delay, both to be treated for the symptoms and to have a different drug prescribed.

For the more common transitory muscle pain, the patient may simply wait it out or take an analgesic, possibly acetaminophen, aspirin, ibuprofen, or naproxen, for temporary relief. Also, "local measures," including physical therapy, massage, heat, or cold, can make the patient feel a lot better. These remedies only provide symptomatic relief, but that may be all that is needed. Statin-induced muscle pain, by itself, does not necessarily predispose the patient to muscle damage later on.

All in all, your chances of experiencing muscle pain from pravastatin are slight, and if you have not had such pain after several months on the drug, the likelihood of having it in the future is especially low. Meanwhile, statins provide significant protection from an array of serious and potentially life-threatening blood vessel conditions. These benefits far outweigh the relatively infrequent and usually benign risks.

-- R. Scott Wright, M.D., Cardiology, Mayo Clinic, Rochester, Minn.