There are a few things to know about statins to help help them work safely and effectively.
This class of medications helps reduce your liver’s ability to make cholesterol, which can lower your levels of LDL (“bad”) cholesterol by as much as 60 percent, offering serious protection against heart attack and stroke.
“Medications such as statin therapy are effective at controlling cholesterol levels, [but] it’s important to take them as prescribed to obtain maximal benefit and reduce side effects,” says Sabrina Islam, MD, MPH, associate professor of medicine at Temple Health Heart and Vascular Institute in Philadelphia.
Make sure your provider knows about all of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you’re taking before starting a statin. Bring a list to your appointment so you don’t miss anything.
While statins have a good safety profile overall, you can experience harmful effects if you take them alongside certain other drugs and dietary supplements. “Some can either increase the potency of statins while others can make them less effective,” says Dr. Islam.
Medications that may interact with statins can include (but aren’t limited to):
Heart rhythm medications, like amiodarone (Cordarone, Pacerone)
Herbal supplements, like chaparral, Chinese skullcap, coltsfoot, comfrey, goldenseal, kava, pomegranate, red yeast rice, and St. John’s wort
Other cholesterol drugs, like gemfibrozil (Lopid)
Protease inhibitors for HIV, like ritonavir (Norvir)
Some antibiotic and antifungal medications, like clarithromycin (Biaxin) and itraconazole (Sporanox, Onmel)
Some immunosuppressants, like oral or intravenous cyclosporine (Neoral, Sandimmune)
Vitamin B3 (niacin)
A statin can help lower your cholesterol and protect against heart attack or stroke, but you reap the biggest benefits when you pair the medication with heart-healthy habits.
“The combined effects of diet, exercise, and a cholesterol-lowering medication, such as a statin, can provide the greatest protection against heart disease and stroke,” says Gordon Huggins, MD, a cardiologist at Tufts Medical Center in Boston.
Choose a heart-healthy diet that’s high in fruits, vegetables, whole grains, poultry, fish, nuts, and nontropical oils (like olive oil) and low in saturated fats and added sugars. Being active matters, too. Aim for at least 150 minutes of moderate-intensity exercise, like brisk walking, bicycling, or swimming, each week.
Statins may make it harder for the body to use blood sugar–regulating hormone insulin effectively, which can raise blood sugar levels slightly, increasing your risk of developing diabetes or making the condition more difficult to manage if you already have it.
It’s important to be aware of this risk so you and your doctor can manage it, but it’s not a reason to avoid taking statins altogether. “Overwhelming evidence supports statins as an important strategy that can reduce the elevated risk of heart disease and stroke in patients who have diabetes and prediabetes,” says Huggins. If you have concerns, share them with your doctor.
The popular breakfast fruit contains enzymes that can make it harder for the body to break down certain statins, increasing your risk for muscle aches and liver dysfunction, says Islam. So if you like to enjoy a grapefruit or a glass of grapefruit juice in the morning, check with your doctor to see whether it’s likely to interact with your statin.
In most cases, you should be able to find a workaround. “Patients who enjoy grapefruit juice can be prescribed a statin that is less affected by grapefruit so they can continue to enjoy this healthy fruit in moderate amounts,” says Dr. Huggins. “Taking the statin in the evening and consuming a moderate amount of grapefruit juice in the morning may help reduce the risk of an interaction.”
Sticking to a consistent schedule ensures that you have the appropriate amount of medication in your system throughout the day (and night). The time you pick may depend on the specific statin your doctor prescribes, along with your preferences. Certain statins work best when you take them before bedtime, while others should be taken with food.
Your doctor can help you figure out the dosing time that works best for your statin. If you have trouble remembering, tie taking your statin to a regular daily event (like brushing your teeth before bed or eating breakfast). Setting an alarm on your phone works, too.
Never stop taking your statin without talking to your doctor first — even if your cholesterol levels have dropped into the normal range. Doing so can cause your cholesterol to go back up, which can significantly increase your heart attack and stroke risk.
“When [you’re] considering stopping statin therapy, there should be a discussion regarding the possible long-term impact on vascular health and whether any alternative therapies should be initiated,” says Islam.
Should you accidentally miss a dose, if you’re less than 12 hours late, take the missed dose as soon as you remember. If you’re more than 12 hours late, skip the missed dose and take your next scheduled dose as prescribed. Avoid taking two doses at once, as doing so could potentially cause harmful side effects.
Mild muscle aches are a common statin side effect. They tend to ease up over time, but you should let your doctor know if they’re bothersome or impacting your normal activities (including exercise), since there are usually things you can do to manage the discomfort.
“Taking statins prior to bedtime and maintaining adequate hydration often limit these side effects,” says Islam. “Additionally, [taking] coenzyme Q10 [CoQ10] in addition to statins can help reduce these symptoms.”
In rare instances, statins can cause rhabdomyolysis, a serious condition in which damaged muscle tissue breaks down and enters the bloodstream. It’s marked by symptoms like muscle weakness, stiffness, or aching, as well as red-colored urine or decreased urine output. Rhabdomyolysis must be treated quickly, so let your healthcare provider know right away if you’re experiencing these symptoms.
Moderation is key if you choose to drink. “Alcohol intake can have a significant impact on liver function when more than one to two beverages for men and one beverage for women are consumed regularly,” says Islam. It can also make your statin less effective or increase your chances of experiencing side effects like muscle aches.
Regardless of your drinking habits, it’s important to be open about them with your doctor. “All patients should describe their alcohol consumption with their doctor because of the risk of liver disease, among other alcohol-related problems,” says Huggins. “Doctors order liver blood tests for people taking a statin to assess whether any liver disease may be present.”
Statins can offer powerful heart-health protection by helping to reduce your LDL cholesterol, and these medications work best when you take them as directed.
Before you start taking a statin, share with your doctor a complete list of every medication and dietary supplement you’re taking to avoid any adverse interactions.
Pair statin use with a heart-healthy diet and regular exercise for the greatest heart-health support.
Track any side effects you experience, such as muscle aches or swings in your blood sugar levels if you have diabetes, and share them with your doctor.
