Written and medically reviewed by Dorcas Morak, Pharm.D
If you have recently been prescribed statins to lower your cholesterol and reduce the risk of heart attacks and strokes, you might be curious about which statin has the fewest side effects. Although highly effective, different statins can have varying side effects. Understanding these differences can help you and your healthcare provider choose the most suitable medication for your condition.
Why Do People Use Cholesterol-Lowering Drugs?
Excessive LDL cholesterol can cause atherosclerosis, narrowing arteries and raising cardiovascular risks. Statins inhibit the enzyme that produces cholesterol in the liver, lowering blood cholesterol levels and reducing these risks.
What Are the Common Side Effects of Statins?
Common side effects of statins include:
- Muscle aches.
- Muscle damage (rhabdomyolysis).
- Liver damage.
- Increased risk of type 2 diabetes.
- Neurological effects.
Who Is at Risk of Statin Side Effects?
Most people tolerate statins well, but some are at higher risk of side effects, including those who:
- Are on other cholesterol-lowering medications (increased likelihood of interactions and cumulative side effects).
- Are over 80 years old (metabolism slows with age, leading to higher drug levels in the body).
- Are female (hormonal differences and smaller body size can influence drug metabolism).
- Have a more petite body frame (higher drug concentration per body weight).
- Have kidney or liver disease (impaired drug clearance).
- Drink excessive alcohol (increased liver stress and potential for liver damage).
- Have conditions like hypothyroidism or ALS (may exacerbate muscle-related side effects).
- Take medications for heart rhythm abnormalities, Gemfibrozil (Lopid), certain HIV medications, some antibiotics, antifungal drugs, and immunosuppressants (higher risk of drug interactions).
What are Examples of Statins and Their Side Effect Profiles?
Not all statins are equal when it comes to side effects. Here are commonly prescribed statins and their relative risk profiles:
- Simvastatin (Zocor) and Pravastatin (Pravachol): Often considered safer options with a lower incidence of side effects, they are well-tolerated and effective for many individuals.
- Atorvastatin (Lipitor): While effective, it tends to be more associated with muscle aches and liver enzyme abnormalities.
- Rosuvastatin (Crestor): Known for its potency in lowering LDL cholesterol, it also has a higher risk of causing muscle pain and liver enzyme elevations.
- Fluvastatin (Lescol), Lovastatin (Altoprev), and Pitavastatin (Livalo): These statins vary in their side effect profiles. Fluvastatin and Lovastatin are associated with higher rates of muscle aches, while Pitavastatin is considered relatively well-tolerated.
Which Cholesterol-Lowering Drug Is the Safest?
Both Simvastatin (Zocor) and Pravastatin (Pravachol) are considered the safest statins, with fewer adverse reactions compared to other statins.
Which Statin is Safest for the Liver?
The safety of statins in patients with moderate to severe liver disease is not proven. Regular liver function tests are crucial to monitor for abnormalities. A low-dose statin like Atorvastatin (Lipitor) is generally safe, even for those with mild liver enzyme issues. Many people with fatty liver disease due to obesity can improve their liver enzyme levels by losing weight.
Which Statin is Less Likely to Cause Muscle Pain?
Hydrophilic statins like Pravastatin (Pravachol) and Rosuvastatin (Crestor) require active transport to muscles and cause fewer muscle aches. Atorvastatin (Lipitor), Simvastatin (Zocor), and Fluvastatin (Lescol) are more likely to cause muscle aches as they are lipophilic and diffuse passively into muscles. If you experience muscle aches on statins, consult your doctor about switching to a hydrophilic statin.
Which of the Statins is the Most Cost Effective?
The cost of statins depends on whether you use generics or brand names and what pharmacy you use. A 30-day supply of Simvastatin 20 mg, Pravastatin 40 mg, Atorvastatin 10 mg, Rosuvastatin 10 mg, and Lovastatin 20 mg cost between $6.80 – $9.11 using the programs found on rxless.com. A 30-day supply of Fluvastatin 40 mg and Pitavastatin 2 mg are more expensive, starting at $41.18. Looking for the most accurate discounts on-the-go? Join the RxLess Assurance Plan by downloading our free app. You will spend less time worried about budgeting for prescriptions and know what you’ll pay at the counter. Every time.
