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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
The side effects of prescription medications are treated a lot like nutritional information on packaged snacks. They’re both listed in the tiniest print available and, though they’re important, some people don’t even check them at all. We could all probably do without the snacks, but medication is more complicated—especially when it comes to statin drugs. Yes, these drugs come with potential side effects such as muscle pain and stomach upset, but they’re balanced by some very big health benefits.
Cardiovascular disease (CVD), which includes conditions like heart attacks and strokes, is a big problem worldwide. Cardiovascular disease is the number one cause of death globally according to the World Health Organization, accounting for an estimated 17.9 million deaths in 2016 alone (WHO, 2017). Statins such as the brand name drug Lipitor are a class of medication that aims to lower high cholesterol levels in people at risk of developing CVD. Elevated cholesterol levels, specifically LDL cholesterol, is one of the six primary risk factors for developing cardiovascular disease (Texas Heart Institute, 2020).
According to the U.S. Centers for Disease Control and Prevention (CDC) more than ¼ of all Americans over the age of 40 are taking cholesterol-lowering medication and 93% of them are on a statin drug (CDC, 2015). And with good reason. Not only do they reduce LDL, they actually make good on their promise of reducing a person’s chance of having a stroke or a heart attack. One study followed patients over 20 years and saw that they had a reduction of 28% in their high levels of “bad” cholesterol after consistent treatment with statin medications (Vallejo-Vaz, 2017).
And while statins are a proven way to reduce cardiovascular disease, they do carry the potential for some unpleasant side effects. Here’s what you need to know about potential Lipitor side effects.
Potential side effects of Lipitor and other types of statins
The most well-known side effect of statins might be muscle pain, but it turns out that not all statins are created equal. Some (like atorvastatin, brand name Lipitor) enter muscle tissue more easily, making them more likely to cause muscle damage than other statins (like Crestor and Pravachol) (Mendes, 2014).
Other common side effects of Lipitor include cold-like symptoms, constipation, diarrhea, fatigue, gas, headache, heartburn, joint pain, nausea, pain in the extremities, and elevated blood sugar levels. More serious side effects such as muscle problems and liver problems are possible but can be alleviated with dosing changes made by a healthcare professional (Pfizer, 2019). For patients over 75 who suffer from high cholesterol levels and patients who have type 2 diabetes, high blood pressure (hypertension), or high triglycerides, combination treatments that contain statins and other cholesterol-lowering medications, like the drug ezetimibe (brand name Zetia) may be a good option for controlling high cholesterol while reducing statin dosage and avoiding unwanted side effects (Bach, 2019; Backes, 2005).
You should not take a statin medication if you’re pregnant or may become pregnant, or if you’re breastfeeding.
Putting side effects in context
Your expectations about statins may shape your experience while taking them, so it’s important to talk to your healthcare provider about statin use. In blinded studies, in which participants don’t know if they’re getting a statin or a placebo, the rates of side effects are low. But when observational studies are done and the participants know they’re taking statins, the rate of reported side effects is much higher (Gupta, 2017).
In fact, when researchers looked at only blinded studies, participants taking atorvastatin (Lipitor) experienced muscular side effects and erectile dysfunction at the same rates as those taking the placebo. Those taking Lipitor also reported fewer sleep disturbances than individuals taking the placebo. The only significant difference the researchers found was that Lipitor was more likely to cause kidney problems than placebo (Gupta, 2017).
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Researchers call this the “nocebo effect.” It’s similar to the placebo effect, which is characterized by experiencing benefits of a medication you’re not actually taking. Since these benefits cannot be attributed to the medication, it’s attributed to the patient’s belief in the treatment. With the nocebo effect, patients experience side effects that cannot be attributed to the medication. Instead, researchers theorize that these side effects happen because people expect them based on exaggerated reports about this prescription drug (Gupta, 2017). Working closely with your healthcare provider to learn about statin therapy may improve your perception of this medication.
When to get medical attention
Do not take statins if you are allergic to any ingredients in the medication. If you experience any of the signs of an allergic reaction, such as hives, rash, facial swelling, or trouble breathing, seek medical attention immediately (Pfizer, 2012). If you have liver problems, make sure to consult with your healthcare provider before starting a statin medication.
Get medical attention if you experience muscle problems or abnormal fatigue without a clear reason. Muscle weakness or tenderness without cause may be a sign of rhabdomyolysis, which is the breakdown of muscle tissue. In addition to muscle pain and weakness, some people may experience dark urine, abdominal pain, confusion, nausea, or vomiting. Since this condition can be dangerous, it’s important to seek medical attention if you develop any of these symptoms while taking a statin medication.
Things to avoid while taking Lipitor
Since Lipitor may interact with other medications, you should speak to a healthcare professional about any prescription drug you’re considering taking and this includes supplements and herbal medications.
Your healthcare provider may recommend avoiding grapefruit juice when taking statins. This citrus fruit contains furanocoumarins, a family of chemicals that inactivates an enzyme in our digestive system called CYP3A4 (Bailey, 2013). This enzyme is supposed to process statins and if it’s inactivated by grapefruit juice, people taking statins will have higher levels of the drug in their blood. Though past research is torn about how much grapefruit or grapefruit juice causes this effect, the consensus currently stands that consumption of 8 oz or less of grapefruit juice per day while taking statins is generally considered to be okay (Reddy, 2011; UpToDate, 2020).
Since the U.S. Food and Drug Administration suggests that you not drink grapefruit juice if you’re taking a statin like Lipitor, reasoning that different people can respond differently to the combination, consult with your healthcare provider to make a decision that is right for you (FDA, 2017).
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Lipitor drug interactions
Certain medications, including medications that also work to lower cholesterol, can increase the risk of side effects caused by statin drugs like atorvastatin. Make sure to inform your healthcare provider of any medications or supplements you are taking.
Cyclosporine and certain HIV medications can also increase the levels of the statins in the bloodstream, increasing the risk of side effects like muscle damage (Pfizer, 2012; Fukazawa, 2004). They increase this risk because, like grapefruit juice, these medications interfere with the normal function of CYP3A4, which processes statins.
Certain medications used to lower high cholesterol levels may also increase the risk of side effects when combined with Lipitor (Pfizer, 2019). This includes fibrates (like Gemfibrozil) and doses of niacin that are capable of affecting lipid levels. In some cases, the benefits of combining these medications outweigh the risks. A medical professional will weigh these factors to determine if this combination therapy is necessary.
People taking both birth control pills and Lipitor may have higher levels of estrogen and progesterone in their bodies. For that reason, your healthcare provider may work with you to find a form of birth control that doesn’t interact with Lipitor (FDA, 2019).
- Bach, R. G., Cannon, C. P., Giugliano, R. P., White, J. A., Lokhnygina, Y., Bohula, E. A., et al. (2019). Effect of Simvastatin-Ezetimibe Compared With Simvastatin Monotherapy After Acute Coronary Syndrome Among Patients 75 Years or Older. JAMA Cardiology, 4(9), 846-854. doi:10.1001/jamacardio.2019.2306. Retrieved from https://jamanetwork.com/journals/jamacardiology/fullarticle/2738104
- Backes, J. M., Gibson, C. A., & Howard, P. A. (2005). Optimal lipid modification: The rationale for combination therapy. Vascular Health and Risk Management, 1(4), 317-331. doi:10.2147/vhrm.2005.1.4.317. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993967/
- Bailey, D., Dresser, G., & Arnold, J. (2013, March 05). Grapefruit–medication interactions: Forbidden fruit or avoidable consequences? Retrieved July 29, 2020 from https://www.cmaj.ca/content/185/4/309
- Food and Drug Administration (FDA). (2014, December 16). Statins. Retrieved July 31, 2020 from https://www.fda.gov/drugs/information-drug-class/statins
- Food and Drug Administration (FDA). (2017, July 18). Grapefruit Juice and Some Drugs Don’t Mix. Retrieved July 29, 2020 from https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix
- Food and Drug Administration (FDA). (2018, June 1). Generic Drug Facts. Retrieved Aug. 9, 2020 from https://www.fda.gov/drugs/generic-drugs/generic-drug-facts
- Food and Drug Administration (FDA). (2019, April). Lipitor (atorvastatin calcium) Label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020702s073lbl.pdf
- Fukazawa, I., Uchida, N., Uchida, E., & Yasuhara, H. (2004). Effects of grapefruit juice on pharmacokinetics of atorvastatin and pravastatin in Japanese. British Journal of Clinical Pharmacology, 57(4), 448-455. doi:10.1046/j.1365-2125.2003.02030.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15025743/
- Gupta, A., Thompson, D., Whitehouse, A., Collier, T., Dahlof, B., Poulter, N., et al. (2017). Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA): A randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. The Lancet, 389(10088), 2473-2481. doi:10.1016/s0140-6736(17)31075-9. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2817%2931075-9/fulltext?elsca1=tlpr
- Mendes, P., Robles, P. G., & Mathur, S. (2014). Statin-Induced Rhabdomyolysis: A Comprehensive Review of Case Reports. Physiotherapy Canada, 66(2), 124-132. doi:10.3138/ptc.2012-65 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006404/#:~:text=Simvastatin%20was%20the%20most%20common,doses%20of%2010%20mg%2Fday.
- Pfizer. (2012, October). Frequently Asked Questions (FAQs) about Lipitor and Cholesterol. Retrieved Aug. 10, 2020 from https://www.lipitor.com/sites/default/files/pdf/Product_Cholesterol_FAQs.pdf
- Pfizer. (2019). HIGHLIGHTS OF PRESCRIBING INFORMATION. Retrieved Aug. 10, 2020 from https://labeling.pfizer.com/showlabeling.aspx?id=587
- Reddy, P., Ellington, D., Zhu, Y., Zdrojewski, I., Parent, S. J., Harmatz, J. S., et al. (2011). Serum concentrations and clinical effects of atorvastatin in patients taking grapefruit juice daily. British Journal of Clinical Pharmacology, 72(3), 434-441. doi:10.1111/j.1365-2125.2011.03996.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21501216/
- Schachter, M. (2005). Chemical, pharmacokinetic and pharmacodynamic properties of statins: An update. Fundamental and Clinical Pharmacology, 19(1), 117-125. doi:10.1111/j.1472-8206.2004.00299.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15660968/
- Texas Heart Institute. (2020, February 3). Heart Information Center: Heart Disease Risk Factors. Retrieved Aug. 10, 2020 from https://www.texasheart.org/heart-health/heart-information-center/topics/heart-disease-risk-factors/
- UpToDate. (2020, June 16). High cholesterol and lipid treatment options (Beyond the Basics). Retrieved Aug. 28, 2020 from https://www.uptodate.com/contents/high-cholesterol-and-lipid-treatment-options-beyond-the-basics
- Vallejo-Vaz, A., Robertson, M., Catapano, A., Watts, G., Kastelein, J., Packard, C., et al. (2017, September 6). Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above. Retrieved from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.027966
- World Health Organization (WHO). (2017, May 17). Cardiovascular diseases (CVDs). Retrieved Aug. 10, 2020 from https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.