Statins Dos and Don’ts

There are a few things to know about statins to help help them work safely and effectively.

This class of medications helps reduce your liver’s ability to make cholesterol, which can lower your levels of LDL (“bad”) cholesterol by as much as 60 percent, offering serious protection against heart attack and stroke.

“Medications such as statin therapy are effective at controlling cholesterol levels, [but] it’s important to take them as prescribed to obtain maximal benefit and reduce side effects,” says Sabrina Islam, MD, MPH, associate professor of medicine at Temple Health Heart and Vascular Institute in Philadelphia.

Make sure your provider knows about all of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you’re taking before starting a statin. Bring a list to your appointment so you don’t miss anything.

While statins have a good safety profile overall, you can experience harmful effects if you take them alongside certain other drugs and dietary supplements. “Some can either increase the potency of statins while others can make them less effective,” says Dr. Islam.

• Heart rhythm medications, like amiodarone (Cordarone, Pacerone)
• Herbal supplements, like chaparral, Chinese skullcap, coltsfoot, comfrey, goldenseal, kava, pomegranate, red yeast rice, and St. John’s wort
• Other cholesterol drugs, like gemfibrozil (Lopid)
• Protease inhibitors for HIV, like ritonavir (Norvir)
• Some antibiotic and antifungal medications, like clarithromycin (Biaxin) and itraconazole (Sporanox, Onmel)
• Some immunosuppressants, like oral or intravenous cyclosporine (Neoral, Sandimmune)
• Vitamin B3 (niacin)

“The combined effects of diet, exercise, and a cholesterol-lowering medication, such as a statin, can provide the greatest protection against heart disease and stroke,” says Gordon Huggins, MD, a cardiologist at Tufts Medical Center in Boston.

It’s important to be aware of this risk so you and your doctor can manage it, but it’s not a reason to avoid taking statins altogether. “Overwhelming evidence supports statins as an important strategy that can reduce the elevated risk of heart disease and stroke in patients who have diabetes and prediabetes,” says Huggins. If you have concerns, share them with your doctor.

In most cases, you should be able to find a workaround. “Patients who enjoy grapefruit juice can be prescribed a statin that is less affected by grapefruit so they can continue to enjoy this healthy fruit in moderate amounts,” says Dr. Huggins. “Taking the statin in the evening and consuming a moderate amount of grapefruit juice in the morning may help reduce the risk of an interaction.”

Your doctor can help you figure out the dosing time that works best for your statin. If you have trouble remembering, tie taking your statin to a regular daily event (like brushing your teeth before bed or eating breakfast). Setting an alarm on your phone works, too.

“When [you’re] considering stopping statin therapy, there should be a discussion regarding the possible long-term impact on vascular health and whether any alternative therapies should be initiated,” says Islam.

Mild muscle aches are a common statin side effect. They tend to ease up over time, but you should let your doctor know if they’re bothersome or impacting your normal activities (including exercise), since there are usually things you can do to manage the discomfort.

“Taking statins prior to bedtime and maintaining adequate hydration often limit these side effects,” says Islam. “Additionally, [taking] coenzyme Q10 [CoQ10] in addition to statins can help reduce these symptoms.”

Regardless of your drinking habits, it’s important to be open about them with your doctor. “All patients should describe their alcohol consumption with their doctor because of the risk of liver disease, among other alcohol-related problems,” says Huggins. “Doctors order liver blood tests for people taking a statin to assess whether any liver disease may be present.”

• Statins can offer powerful heart-health protection by helping to reduce your LDL cholesterol, and these medications work best when you take them as directed.
• Before you start taking a statin, share with your doctor a complete list of every medication and dietary supplement you’re taking to avoid any adverse interactions.
• Pair statin use with a heart-healthy diet and regular exercise for the greatest heart-health support.
• Track any side effects you experience, such as muscle aches or swings in your blood sugar levels if you have diabetes, and share them with your doctor.