Doctors commonly prescribe statins to treat high cholesterol, but they can help diagnose a rare statin intolerance and offer possible alternatives if you have side effects like muscle pains, cramps, or inflammation.

Doctors often prescribe statins to people with high cholesterol or who have a higher risk for cardiovascular issues. Statins work by blocking the enzyme that makes cholesterol in your body and helping reduce your cardiovascular risk.

But statins aren’t for everyone. Although it’s rare, some people can develop an intolerance to statins, and that can become dangerous.

This article focuses on statin intolerance, the symptoms you might experience, and what you can discuss with your healthcare team as an alternative to taking statins if they feel that’s necessary.

Statin intolerance occurs when a person develops side effects from statin use that interfere with their ability to take this type of medication.

The National Lipid Association (NLA) released an updated definition of statin intolerance in 2022, clarifying what this means to help better guide the medical community in diagnosing and advising people about statin use.

That definition states that statin intolerance is “one or more adverse effects associated with statin therapy which resolves or improves with dose reduction or discontinuation… and can be classified as a complete inability to tolerate any dose of a statin or partial intolerance with inability to tolerate the dose necessary to achieve the patient-specific therapeutic objective.”

The NLA noted that someone would need to have taken at least two statins, with one at the lowest daily dosage.

This 2021 review of research recognizes the reality of statin intolerance but notes that it’s often over-diagnosed when factoring in different definitions worldwide and how people may not be taking their medication as needed.

You may notice different symptoms if you’re experiencing this type of medication intolerance.

The most common side effects typically involve the muscles, known as statin-associated muscle symptoms (SAMS). These may include muscle pains or cramps (myalgias), which is one of the more common muscle-related symptoms people experience.

Muscle inflammation and possible spasms are also possible, and although it’s rare, severe muscle toxicity can also occur.

Beyond those muscle-related symptoms, other symptoms may include:

The medication may not cause these symptoms, but your doctor will conduct tests and obtain background information to determine this. They may also perform tests or change the statin or dosage to determine if symptoms improve.

Read more here about other statin-related side effects.

Your doctor may have you stop taking statins to see if your symptoms stop and then slowly reintroduce the drug to see if your symptoms return.

Your doctor may also do the following to help diagnose statin intolerance:

  • perform a full medical evaluation
  • perform a blood test to show if you have any abnormalities, such as high levels of creatine kinase or liver damage
  • review your family history to see if others in your family have statin intolerance
  • conduct a muscle biopsy to remove a small amount of muscle for testing
  • require a symptom questionnaire where you describe your symptoms
  • conduct a muscle strength test to evaluate the strength of your muscles

Certain factors may put you at an increased risk for statin intolerance:

  • female
  • Asian ethnicity
  • certain preexisting conditions, such as neuromuscular, kidney, or liver conditions
  • excessive alcohol consumption
  • excessive exercise
  • grapefruit juice consumption

You can experience more serious health issues because of a statin intolerance.

This can include an increased risk of cardiovascular events, including heart attacks and strokes for the first time or repeat events. On a related note, statin intolerance may also lead to higher cholesterol levels.

Many statin problems are related to dosage.

Your doctor may reduce the amount you’re taking to see if it reduces your symptoms. They may prescribe a lower dosage or even decrease the number of days per week you take your medication.

They may also encourage lifestyle changes. A balanced diet can help lower cholesterol naturally and decrease your cardiovascular risks.

Your doctor may change which statin you’re taking. There are several statin options, and you may react better with a different type. Your doctor may also prescribe non-statin cholesterol-lowering drugs.

When to consult your doctor

You may consult your healthcare team if you are experiencing statin side effects. A different medication you’re taking could cause side effects that could cause or indicate an underlying condition.

Resolving your symptoms may be as simple as switching your medication. Statins are the most popular and effective cholesterol medication, but there are alternatives that your doctor may prescribe.

Aside from lifestyle changes or switches to a different type of statin, your doctor may also suggest alternatives to statins. These are newer medications that have become available in recent years.

Although statins may be a daily pill that you take, other types of medications may require injections. Possible alternatives that your doctor may discuss with you include:

  • PCSK9 inhibitors: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a newer alternative to statins, which require regular injections. A 2019 review of studies found that PCSK9 inhibitors were more effective than statins at reducing cholesterol, achieved similar cardiovascular benefits, and did so with a lower risk of side effects than statins. You may recognize these by their names: Alirocumab (Praluent), Evolocumab (Repatha), and Inclisiran (Leqvio).
  • Ezetimibe (Zetia): This prescription tablet is in a class of selective cholesterol-absorption inhibitors designed to reduce total cholesterol and lower LDL and non-HDL levels in people with certain higher cholesterol-related conditions or family histories.
  • Bempedoic acid (BDA): This is a prescription tablet taken once a day to help lower LDL cholesterol levels.

This 2021 research notes that some of these options may be as effective as or more effective than statins, depending on the individual situation. However, these are newer medications, and additional research is needed to determine their benefits, risks, and how they compare to statins.

In 2022, an expert consensus by the American College of Cardiology pointed out that 90% of people may actually experience statin-associated side effects by simply taking a pill, whether it’s a statin or not — known as the “nocebo effect.”

The expert consensus noted that doctors should evaluate any symptoms that might relate to statins. If so, they may adjust the person’s dosage to the highest point they can safely take that medication without severe side effects limiting their medication use.

As always, your healthcare team can advise on whether a non-statin alternative may be an option for you.

While serious side effects from statins are rare, some people may experience muscle-related issues or other symptoms after taking statins. You can discuss symptoms, including muscle-related pain or other symptoms, with your healthcare team.

Make sure to consult your doctor before making any changes to your medications, and consult with them first before stopping any statin you’ve been prescribed. They can advise you about possible dosage changes or alternatives.