Muscle Pain From Statins? Here’s How to Avoid It

Written by Megan N. Freeland, PharmD, RPh | Reviewed by Joshua Murdock, PharmD Updated on March 31, 2022  from Good Rx

Key takeaways:

• Statins are first-choice options to lower cholesterol levels. Statins can also help lower heart-related risks, like heart attack and stroke.
• While statins are effective medications, they can cause muscle pain and other side effects.
• If you have muscle pain from statins, you may be able to take a different statin or different cholesterol-lowering medication.

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Statins are one of the most popular classes of prescription drugs. These potentially lifesaving medications have some important medical uses. The downside is that they can also cause muscle pain or muscle cramps — also known as statin-induced muscle pain. Approximately 5% to 20% of people taking statins experience this side effect.

Let’s find out why statins can cause muscle pain and what you can do to avoid it. In this article, we’ll also talk about other side effects with statins.

Why do people take statins? 

Statins keep your liver from making too much cholesterol, but they are also useful for other reasons. For example, people who have or are at high risk for heart disease can benefit from statins. This is because these medications help reduce the risk of hospitalization and death from heart-related complications like heart attacks and strokes. It’s estimated that almost a third of adults older than 40 years old take a statin medication.

Statins approved in the U.S. include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)
• Pitavastatin (Livalo)

If you’re prescribed a statin, it’s important to take it as directed. But, it turns out, some people may find that challenging because of a certain side effect: muscle pain.

Why do some people experience muscle pain with statins?

Not everyone who takes a statin will have muscle pain. Muscle pain from statins might also show up differently for different people. For example, you could feel muscle weakness, soreness, aches, stiffness, or cramps. These side effects can range from mildly irritating to almost unbearable. 

The older you are, the more likely you are to experience statin-induced muscle pain. Other possible risk factors may include: 

• Being female 
• Being thin
• Having other medical conditions — like diabetes, high blood pressure, untreated low thyroid condition, and kidney or liver disease

How do statins cause muscle pain?

We don’t know for sure how statins cause muscle pain as a side effect, but researchers have a few ideas. 

• Genetics: Certain genes may make it more likely for you to experience muscle pain after taking statins.
• Muscle fiber type: Your muscles have two types of fibers: slow-twitch oxidative (type I) fibers and fast-twitch glycolytic (type II) fibers. The type I fibers help you with low-intensity and long-duration exercises. And the type II fibers help with high-intensity and short-duration exercises. If you have more type II muscle fibers, you’re more likely to have muscle pain from statins.
• Protein prenylation impairment: Several proteins require prenylation (modification) by lipids (fats) to know where to go and how to work. Having protein prenylation impairment is linked to statin-related muscle pain.  
• Low cholesterol in muscles: Statins may block muscle cells from making cholesterol. But it’s unknown if low cholesterol levels in muscles can cause muscle pain. More studies are needed.
• Mitochondrial dysfunction and free radicals: The mitochondria is a structure in many human cells. It also makes energy. Statins can prevent the mitochondria from working as well. This may eventually lead to the presence of free radicals that play a role in statin-related muscle pain. 
• Low vitamin D: There is a possible link between low vitamin D and statin-related muscle pain. But more studies are needed.
• Calcium leakage: Calcium helps muscles contract. But when calcium leaks from muscle cells unintentionally, it can damage your muscle cells, which can cause muscle pain and weakness. Recent research suggests that statins may worsen this unintentional leakage, but more research is also needed to confirm this.

Is muscle pain a side effect of all statins?

Even though all statins are similar chemically, they have some minor differences that could impact how likely they are to cause muscle pain.

Simvastatin is the most likely to cause muscle pain, and fluvastatin is the least likely. Of course, this isn’t written in stone, since it’s possible for any statin to have this effect. Figuring out which statin doesn’t cause muscle pain for you may require some trial and error.

Can muscle pain from statins be dangerous or life-threatening?

It’s rare, but it’s possible. If you notice that your muscle pain is accompanied by dark-colored, brownish urine, get medical attention right away. This could be a sign of a serious condition called rhabdomyolysis (muscle breakdown) that can lead to kidney failure and death.

Does muscle pain from statins go away?

In most cases, if you’re going to have muscle pain from statins, you will notice it soon after you start taking the medication. For many people, however, this side effect is temporary and goes away somewhat quickly.

It’s also true that even someone who’s been taking a statin for at least a year without issue can suddenly develop muscle pain, cramps, weakness, or soreness. Granted, it’s difficult to tell if those muscle-related side effects are directly linked to the statin or if they’re caused by other health conditions. 

Muscle pain usually goes away within 1 to 2 weeks after you stop taking a statin. If the pain doesn’t go away, it may have been caused by something else.

What are my options if a statin is causing unbearable muscle pain?

If you’re unable to tolerate your statin because of its effects on your muscles, you have a few options to resolve the problem.

Ask a pharmacist to review your entire medication regimen

Many medications and supplements can interact with statins and raise the levels of statins in your body. In most cases, if statin levels increase, you are more likely to have muscle-related side effects. Asking your pharmacist to review your medication regimen helps ensure there aren’t any drug interactions that could be causing or worsening your pain.

Ask your healthcare provider about trying a different statin

Let your healthcare provider know ASAP if you begin to have muscle pain while taking a statin medication. They will likely do a physical exam and run tests to see whether the statin is actually the cause. If so, they may ask you to take a break from the statin or switch to another one to see if the muscle pain improves.

In fact, experts recommend this approach, which has helped many people tolerate at least one statin. 

So, unless you had a life-threatening reaction to a statin or are unable to take it, it’s probably a good idea to try another statin or two before writing all of them off. 

Consider an alternative cholesterol-lowering medication

While statins are among the most effective medications for getting your cholesterol under control, they certainly aren’t the only options. Ask your healthcare provider whether it may be appropriate for you to try another cholesterol-lowering medication, like ezetimibe (Zetia), niacin ER (Niaspan), or fenofibrate (Tricor).

Other statin side effects to know

In addition to muscle pain, statins also have the following possible side effects: 

• Diabetes: Statin therapy is connected to a moderate diabetes risk in people with other risk factors for diabetes. Some of these risk factors may include: age of 45 years or older, personal history of diabetes during pregnancy, and family history of diabetes. Experts, however, still believe that the benefits of preventing a heart attack, stroke, or heart-related death outweigh the diabetes risk.

• Kidney injury: Statins can cause kidney injury because of rhabdomyolysis. But, in the absence of severe muscle breakdown, long-term use of statins isn’t connected to worsening kidney function. A 2016 study, however, suggested a risk of kidney injury when taking a statin around heart surgery.
• Liver toxicity: Although liver toxicity is a possible side effect with statins, it is very rare.
• Steroid hormone effects: Statins might slightly lower the amount of testosterone in the body. But this effect is not enough to cause hypogonadism (medical condition of low testosterone) or erectile dysfunction (ED) in men. 
• Stroke: There is a higher risk of hemorrhagic stroke (bleeding in the brain from a ruptured or torn blood vessel) with statin use in people who already had a stroke. Since this is a small risk, however, experts believe that the benefits of statins still outweigh the risks.

The bottom line

Statins are effective medications that can lower cholesterol levels and the risk of stroke or heart attack. Many people, however, have concerns about statin-induced muscle pain and other possible side effects.

In general, the benefits of statin use outweigh its risks. If you’re experiencing muscle pains, however, talk with your pharmacist or healthcare provider, who will find ways to help you avoid this side effect. They might be able to address your questions about other statin-related side effects, too.