Statins
Tablets that lower LDL (“bad”) cholesterol and cut heart attacks and strokes. Some of the most studied medicines on the planet, and the subject of even more internet myths.
At a glance
- For
- Preventing heart attack and stroke: after one, or when your risk is high; high cholesterol, including the inherited kind
- Works
- Lower LDL cholesterol by about 30–55%, depending on the statin and dose. Each 1 mmol/L drop in LDL cuts heart attacks and strokes by about a fifth
- Cost
- Under the $25 PBS co-payment, about $21–22 a month for generics (brand premium extra); $7.70 concession. 60-day scripts for some
- Kicks in
- Cholesterol falls within 2 weeks, near full effect by 4–6 weeks; heart protection builds over years
- Taken for
- Long term, usually for life
- Watch for
- Muscle aches (usually not the statin), headache, tummy upset or wind, changes in liver tests
In blinded trials, most muscle aches turned up just as often on dummy tablets. Achy? Talk to your GP about a switch, a lower dose or a short break, rather than quietly retiring the tablets to the pantry.
Brand names
- Atorvastatin: Lipitor, Lorstat, Atorvachol, Trovas, plus generics
- Rosuvastatin: Crestor, plus generics
- Simvastatin: Zocor, Lipex, plus generics; pravastatin: generics
- Combinations: with ezetimibe (Rosuzet, Vytorin) or amlodipine (Caduet)
How it works
Statins block an enzyme the liver needs to make cholesterol. The liver then pulls more LDL out of the blood, and fatty plaques in arteries become more stable.
Used for
- Lowering the risk of heart attack and stroke in people with heart or blood vessel disease, diabetes, kidney disease or a high calculated risk
- High cholesterol, including familial (inherited) hypercholesterolaemia
Side effects
Full side-effect list (from the product information)
How often, from the atorvastatin product information (other statins are similar). Bold = serious.
Common 1 in 10 to 1 in 100
- Muscle aches, cramps, joint or back pain
- Headache
- Nausea, indigestion, wind, constipation, diarrhoea
- Sore throat, cold-like symptoms, nosebleeds
- Higher blood sugar
- Changes in liver or muscle (CK) blood tests
Uncommon 1 in 100 to 1 in 1,000
- Poor sleep, nightmares, dizziness
- Tingling or numbness, taste changes
- Blurred vision, ringing ears
- Rash, itch, hives, hair loss
- Tiredness, swelling
- Pancreatitis, hepatitis
Rare 1 in 1,000 to 1 in 10,000
- Myopathy, myositis
- Rhabdomyolysis (muscle breakdown)
- Tendon problems
- Nerve damage in the hands or feet
- Severe skin reactions, angioedema
Very rare fewer than 1 in 10,000
- Anaphylaxis
- Liver failure
- Hearing loss
- Breast enlargement in men
Frequency not known reported, rate unclear
- Immune-mediated necrotising myopathy (ongoing weakness after stopping)
Get help urgently if
- Unexplained muscle pain, tenderness or weakness, especially with fever, feeling unwell or dark, cola-coloured urine (possible muscle breakdown, rare)
- Yellow skin or eyes, or severe tummy pain
- Swelling of the face or throat, trouble breathing, or a blistering rash
Good to know
- Muscle aches: more than 9 in 10 muscle complaints in trials weren’t caused by the statin. If aches are real and bothersome, a different statin, lower dose or added ezetimibe often works.
- Interactions: some antibiotics (such as clarithromycin), antifungals, HIV medicines, gemfibrozil and colchicine raise statin levels. Large amounts of grapefruit juice do too, with atorvastatin and simvastatin.
- Diabetes: statins slightly raise the chance of a diabetes diagnosis, mainly in people already close to it. For people who need a statin, the heart benefits outweigh this.
- Pregnancy: not used in pregnancy or breastfeeding. Stop before trying to conceive.
Common questions
Do statins cause muscle pain?
Sometimes, but much less often than people think. In blinded trials, more than 9 in 10 muscle complaints happened just as often on a dummy treatment. Serious muscle damage is rare.
Can I stop my statin once my cholesterol is normal?
Usually not. Your cholesterol is normal because of the statin, and it rises again within weeks of stopping. Talk to your GP before stopping.
Do statins affect memory?
Large reviews of trial data haven’t shown a clear effect on memory or dementia. If you notice changes, raise them with your doctor.
Do I need to take a statin at night?
Atorvastatin and rosuvastatin work at any time of day. Simvastatin and pravastatin are usually taken in the evening.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- Cholesterol Treatment Trialists: Efficacy and safety of more intensive LDL lowering (The Lancet, 2010)
- Cholesterol Treatment Trialists: Statins and muscle symptoms (The Lancet, 2022)
- SAMSON trial: Statin, placebo or no tablet (NEJM, 2020)
- PBS: Atorvastatin 20 mg
- PBS: Rosuvastatin 10 mg
- Healthdirect: Medicines information
maladywise.com/medicines/statins/