If adverse reactions occur while taking statins, should I stop taking the medicine?

Statins are the "cornerstone" drugs for preventing cardiovascular and cerebrovascular diseases. Many friends asked Huazi, if adverse reactions occur while taking statins, should they stop taking the drugs immediately?

Hua Zi said that the overall incidence of adverse reactions to statins is not high. Relevant studies have shown that only about 1% of people taking statins will experience adverse reactions. However, due to the large patient base, the absolute number of people who experience adverse reactions is still large, and it should be taken seriously. The severity of the adverse reactions should be used to determine whether the drug needs to be discontinued.

1. How to deal with a new case

In the past, the discontinuation criteria for adverse reactions to statins required one of two conditions to be met: one was that the transaminase (AST, ALT) exceeded the normal level by 3 times (about 120 IU or more); the other was that the creatine kinase (CK) exceeded the normal upper limit by 5 times (about 1000 IU or more).

However, at the 2022 American College of Cardiology Annual Meeting (ACC2022), an expert shared a case.

The patient had hyperlipidemia, hypertension, smoking, and obesity, but was intolerant to atorvastatin and pravastatin. So he was treated with rosuvastatin 5 mg per day. After three and a half weeks of medication, the patient developed myalgia and weakness, and CK soared to 13943, AST rose to 82, and ALT rose to 74.

According to the standard treatment, the patient should stop taking the medicine. However, the expert found that the patient had a problem with alcoholism, and after taking the medicine, the patient did high-intensity exercise on his own and lost 18 kilograms in 3 and a half weeks. Therefore, it was inferred that alcohol may have caused liver damage, causing elevated transaminases; high-intensity exercise caused muscle damage, resulting in elevated CK values, and rosuvastatin further exacerbated the situation.

The specialist reduced the dose of rosuvastatin to 1.25 mg per day and added ezetimibe 10 mg. The patient also quit smoking and drinking, followed a low-fat diet, and exercised moderately. As the patient gradually tolerated the drug, rosuvastatin was resumed at 5 mg per day, and the adverse reactions did not recur.

2. It is not recommended to stop taking statins at will

Among the inquiries about statins, Huazi is most often asked how long to stop taking the drug. Huazi said that for people with atherosclerosis who take statins to prevent thrombotic diseases such as myocardial infarction and cerebral infarction, it is not recommended to stop taking statins, but to take them as long as possible.

Because statins can not only lower blood lipids, but also increase the stability of atherosclerotic plaques, which can prevent plaque rupture and induce platelet aggregation to form thrombi. If statins are discontinued, the incidence of myocardial infarction and cerebral infarction will increase significantly.

3. Finding non-drug causes

Many people want to stop taking statins, mainly because they experience muscle soreness while taking the medication, which leads to their subjective desire to stop taking the medication. However, severe rhabdomyolysis caused by statins is an extremely rare event with a low probability of only 0.15 deaths for every one million prescriptions.

Some people may experience intolerance when taking statins, but some symptoms may not be directly caused by the drugs. For example, in the case in this article, adverse reactions occurred during medication, which were actually related to alcohol and high-intensity exercise. After timely intervention and adjustment of medication, the symptoms were well controlled and statins were not discontinued.

So, considering stopping statins just to get rid of mild muscle pain is probably not a wise choice.

In summary, the use of statins may cause adverse reactions, but there may also be symptoms caused by other factors. It is recommended to communicate with the doctor in time, find the cause and correct it, and adjust the drug dosage under the doctor's guidance, use it in combination with other lipid-lowering drugs, or switch to other statins, and try to maintain statin treatment to avoid the increased risk of cardiovascular and cerebrovascular diseases due to discontinuation of the drug.

If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.