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July 4, 2020
 

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Dr.Samuel Heiks: Bothered by statin muscle aches. What to do?

Dr. Heiks is a board certified Family Medicine doctor and lives in  Bluffton, Ohio. This is a new column on The Icon.

Dear Dr. Heiks: I have a hard time taking statin medicines because of muscle aches. I’ve had a heart attack and my doctor really wants me to stay on cholesterol medicine.  What should I do?  Reader from Bluffton, Ohio

Dear Reader: No medicine is free from potential unwanted side effects, and the statin medications, used to lower cholesterol, are no exception. The most common side effect is muscle pains (myalgias). There can also be inflammation (myositis) and rarely, muscle breakdown (rhabdomyolysis). Additionally, these reactions may unmask an underlying metabolic disorder, such as low thyroid function or a low vitamin D level.

It is important to check with your doctor to determine if the cause is truly from the statin, and, if so, the right course of action for you.  Sometimes blood work is required to further investigate the problem.

This disclaimer aside, statin myalgias are a common problem: roughly 10 – 20 % of people have this adverse reaction. Strangely, myalgias can pop up at any point in time (even years) after the medication has been started, but usually manifest in the first six months.  Thankfully, measures can be taken to address the problem.

One option is to simply take a drug holiday – go off the drug entirely – for a week or two.  When the holiday is over, resume the medicine at its usual dosage or at a lower dosage.  This break may be all that is needed to completely alleviate myalgias.  If the symptoms return (and it’s clear the holiday is over) you should consider another option.

Another approach is to change the dosing regimen, which may work particularly well for longer acting statins such as rosuvastatin (Crestor) or atorvastatin (Lipitor). Switching to taking the medication every other day, rather than every day may be an option – although the pharmacist may look at you a little funny when the prescription is written this way. 

Sometimes changing medication altogether is what is required. There are high and low potency statins and lower potency statins generally have fewer side effects. The effect of low potency statins on cholesterol may not be as strong, yet this may be enough to meet your goals.  Additionally, both low and high potency statins work to decrease inflammation.  This may be as important as the effect on cholesterol for prevention.

Another option is to add coenzyme Q10 at a dose of at least 200 mg daily to the medication.  While the evidence is somewhat equivocal, it is certainly safe to try. Statins decrease coQ10 in levels in the body, and certain people are especially sensitive to this. CoQ10 is important for energy production in the cells.

Finally, Red Yeast Rice extract may be a consideration. Red Yeast Rice contains monacolins - naturally occurring substances that lower cholesterol - first used in the Tang Dynasty in China around 800 A.D. Several studies have shown that this may be an alternative to patients who simply cannot tolerate the prescriptions. One note of caution: Red Yeast Rice is notorious for contamination with a kidney toxin – so you want to ensure the purity. A good resource to do this is ConsumerLab.com. Again, check with your doctor before starting any nutritional supplement.

Statin myalgias are bothersome and common but can often be managed together with your doctor with a plan that is personalized to you.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Heiks to people submitting questions.

Please email your question to Dr. Heiks: heiks@creeksidebluffton.com  If your question is selected your identity will remain confidential.