What Do I Need to Know About Statins to Lower Cholesterol?

Statins are also called HMG-CoA reductase inhibitors. They are the medicines of choice for lowering cholesterol.

When Are Statins Prescribed?

Your doctor is likely to prescribe a statin to help lower your cholesterol if any of the following apply to you.
  • You have high LDL - known as the bad cholesterol.
  • You have severe high cholesterol or coronary heart disease, called CHD.
  • You are middle-aged or older and have multiple risk factors for heart disease.
  • You have diabetes.
  • You have certain types of inherited high cholesterol or high cholesterol caused by the kidney disease called nephrotic syndrome.
If your doctor has prescribed a statin for you, be sure to take it as directed.

Common Names of Statins

The following table shows some of the most common brand and generic names for this type of medicine.

brand generic
Lescol fluvastatin Na
Lipitor atorvastatin Ca
Mevacor lovastatin
Pravachol pravastatin Na
Zocor simvastatin

How to Take It

Statins are usually taken by tablet or capsule once a day, usually in the evening.

How Statins Work

Statins work by blocking a substance that your liver needs in order to make cholesterol. That means less cholesterol is released into your circulating blood. Statins are very effective in lowering LDL - the bad cholesterol - by 18% to 55%. They may also raise HDL - the good cholesterol - by 5% to 15%. In addition, they may decrease triglycerides by 7% to 30%.

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Precautions and Possible Side Effects With Statins

Precautions to take when you are on statins:

  • Remind your doctor of your age. Unless the cholesterol is very high, statins are not usually the first medicine of choice for young adults who don't have CHD.

  • Keep all your follow-up visits with your doctor - especially when you first start taking a statin and any time your dose is changed. Your doctor will check your liver enzymes 6 to 12 weeks after you first start taking a statin with a blood test to make sure that liver damage is not occurring. You will then need a blood test to check your liver about every 4 to 6 months once you are on a set dose of your statin. If your liver enzymes or creatine kinase values rise to more than three times the normal limit, you should stop taking statins.

  • Tell your doctor if you are pregnant or if you have active or chronic liver disease. People with these conditions should not take statins.

Taking these actions will help ensure that you take your statins safely.

Most Common Side Effects. The most common side effect of statins is gastrointestinal upset. This may include:

  • constipation
  • cramping
  • diarrhea
  • gas
  • heartburn
  • indigestion
  • nausea
  • stomach pain
Less Common Side Effects. You may also have these less common side effects:
  • blurred vision
  • dizziness
  • headache
  • liver damage, which sometimes causes yellowing of eyes and skin
  • rash

Severe Side Effects. Less often, statins may cause severe side effects. Report any muscle pain or brownish or rust-colored urine to your doctor immediately. Some people have muscle pain when taking statins. In rare cases, people taking statins develop a condition that causes muscle weakness and wasting of muscle tissue called myopathy. Severe myopathy is more frequent in people who take high doses of some statins along with cyclosporine, gemfibrozil, or nicotinic acid. Taking erythromycin or itraconazole along with some statins may increase your risk for muscle inflammation.

Tell your doctor immediately if you develop muscle aching, weakness, or dark urine. If any of these things occurs, your doctor may order a blood test to measure a muscle enzyme in the blood called creatine kinase.

In rare cases, statin medicines have been linked with liver inflammation, called hepatitis. To be on the lookout for that, your doctor will monitor your liver function.

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Possible Drug Interactions With Statins

Make sure your doctor is aware of all the medicines that you are taking before you start any new medicines. Also, ask your pharmacist for a complete list of possible interactions with the statin medicine your doctor prescribes. Statins may interact with the following:

  • alcohol
  • antacids
  • the cholesterol medicines bile acid resins, gemfibrozil, and nicotinic acid
  • cyclosporine, which suppresses the immune system
  • the antibiotics erythromycin and rifampin
  • the ulcer medicines cimetidine, ranitidine, and omeprazole
  • propranolol, used for blood pressure or heart conditions
  • oral contraceptives
  • digoxin, a heart medicine
  • warfarin, a blood thinner
  • the antifungal medicines fluconazole, itraconazole, and ketoconazole
If you take atorvastatin, your skin may be more sensitive to sunlight. So take care not to get sunburned.

If you take lovastatin, avoid taking it with grapefruit juice. It may interact dangerously with your medicine, causing higher levels of lovastatin in your blood. The potential increase is unpredictable and may worsen side effects.

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