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Statins: How They Work, Side Effects (cont.)
Annette (Gbemudu) Ogbru, PharmD, MBA
Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- What are statins and how do they work?
- For what conditions are statins used?
- Are there differences among statins?
- What are side effects of statins?
- What are the drug interactions with statins?
- What are some examples of statins approved by the FDA in the U.S.?
What are side effects of statins?
Common side effects include
- headaches,
- diarrhea,
- nausea,
- fever,
- vomiting,
- constipation,
- rash,
- dyspepsia, and
- flatulence.
The serious side effects include extreme muscle pain, rhabdomyolysis, and serious liver problems.
What are the drug interactions with statins?
Statins [atorvastatin (Lipitor), lovastatin (Mevacor, Altocor), fluvastatin (Lescol), and simvastatin (Zocor)] when taken together with itraconazole (Sporanox), erythromycin (for example, Benzamycin, Emgel, Ilotycin, Staticin), protease inhibitors, nefazodone (Serzone), cyclosporine (Sandimmune, Neoral, Restasis), diltiazem (Cardizem LA, Cardizem Injection, Tiazac), verapamil (Covera-HS, Verelan PM, Calan), and grapefruit juice could cause an interaction that blocks the enzymes in the liver that eliminate statins from the body. This causes an increased level of statins that could result in an increased risk of myopathies and rhabdomyolysis.
Bile acid sequestrants [colestipol (Colestid) and cholestyramine (Questran, Questran Light)] prevent the absorption of statins into the body by binding to them in the intestine. It is recommended that statins be ingested one hour before or four hours after cholestyramine (Questran, Questran Light) or colestipol (Colestid) .
Statins [fluvastatin (Lescol), lovastatin (mevacor, Altocor), rosuvastatin (Crestor), and simvastatin (Zocor)] when taken with warfarin (Coumadin) may cause an increased risk in bleeding. Atorvastatin (Lipitor) and pravastatin (Pravachol) do not have clinically significant effect when given with warfarin (Coumadin).
An increased risk of rhabdomyolysis or liver failure can occur when statins are taken with niacin [nicotinic acid (Niaspan, Niacor)], or fibric acids [gemfibrozil (Lopid), clofibrate (Atromid-S), and fenofibrate (Tricor)].
St John’s Wort decreases the levels of lovastatin (Mevacor, Altocor) and simvastatin (Zocor) and could possibly reducing efficacy of the specified statins.
What are some examples of statins approved by the FDA in the U.S.?
Statins that are approved for use in the U.S. include:
- atorvastatin (Lipitor),
- fluvastatin (Lescol),
- lovastatin (Mevacor, Altocor)
- pravastatin (Pravachol),
- rosuvastatin (Crestor),
- simvastatin (Zocor ), and
- pitavastatin (Livalo).
Last Editorial Review: 9/8/2008
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