What are the potential side effects of statins, and how should I address them with my patients?

Potential side effects of statins include muscle symptoms such as pain, tenderness, or weakness, which are generally uncommon, and severe muscle adverse effects like rhabdomyolysis are extremely rare.

Other possible side effects can include raised liver transaminase levels, but mild elevations (less than 3 times the upper limit of normal) should not routinely exclude statin treatment.

How to address side effects with patients:

• Advise patients to report any unexplained muscle symptoms promptly.
• If muscle symptoms occur, consider stopping the statin temporarily to see if symptoms resolve, then re-challenge to confirm causality.
• Try switching to a different statin within the same intensity group or reduce the statin dose if symptoms persist.
• If high-intensity statins are not tolerated, aim to treat with the maximum tolerated dose and consider alternate-day or twice-weekly dosing regimens, especially with atorvastatin or rosuvastatin due to their longer half-lives.
• Do not routinely measure creatine kinase (CK) in asymptomatic patients; measure CK if there are persistent unexplained muscle symptoms or history of muscle problems.
• Provide annual medication reviews to discuss adherence, side effects, and reinforce lifestyle changes.
• Advise patients about potential drug and food interactions (e.g., grapefruit juice) that may increase side effects.
• Do not offer coenzyme Q10 or vitamin D to improve adherence as there is no evidence supporting their use for this purpose.

These approaches help balance the benefits of statins in reducing cardiovascular risk with managing and minimising adverse effects.

Summary: Muscle symptoms are the most common side effects; manage by dose adjustment, switching statins, or altering dosing frequency. Monitor liver enzymes but do not withhold treatment for mild elevations. Annual reviews and patient education on side effects and interactions are essential.

References: ¹,²,³