How can I avoid statin side effects?

What are the side effects of statins?

In the short term, the most common statins side effects are related to your digestive system. For example:

• Bloating.

• Diarrhoea or constipation.

• Tummy pain.

Muscle pain and weakness

In the longer term, muscle and sometimes joint aches are probably the most troublesome side effect - they may affect up to 1 in 10 people taking statins and they tend to be more common and more severe with higher doses.

Your doctor will be able to tell you if you are on a relatively high dose, depending on the type of statin you take.

Anyone who gets severe muscle aches and weakness should see their doctor urgently - there is a very rare but potentially very serious side effect of statins called rhabdomyolysis.

How to relieve statin side effects

These side effects usually settle within a few weeks and can often be reduced by starting on a lower dose and increasing as the side effects settle.

For instance, with simvastatin, while the standard dose is 40 mg, I usually tell my patients to take half a tablet for a few weeks and then increase to a whole tablet once any side effects have gone.

The biggest benefit from taking a statin comes from the initial dose - you don't get a doubling of the reduction in your cholesterol by doubling the dose. In fact, every doubling of the dose of statin only reduces LDL cholesterol - also called bad cholesterol - by a further 6%, compared to a reduction of up to 40% with the first 10 mg dose. If your side effects are having a significant impact on your life, something needs to be done.

However, if you have any significant degree of blockage of your coronary arteries you are likely to be at high risk of heart attack, and reducing your cholesterol with a statin will greatly reduce this risk.

There are several possible options, which I suggest you discuss with your doctor before doing.

1. Reduce your dose - for example, if you are taking 40 mg atorvastatin, I recommend you take this down to 20 mg. If that doesn't help, try reducing to 10 mg.

2. Change to a statin with a lower risk of these side effects - for example, if you are on atorvastatin you could discuss changing to rosuvastatin with your doctor. However, because rosuvastatin is many times more expensive than atorvastatin, some areas have limits on who can receive this statin.

3. If your cholesterol rises too much when the dose of statin is reduced, add in another medicine called ezetimibe - although this is not as effective as statins.

If your statins side effects includes muscle symptoms, some people find that these improve if they also take a supplement called co-enzyme Q10 - although there is less evidence for this with joint problems.

Can you stop taking statins once you start?

It is worth stopping your statin for a couple of weeks to see if the symptoms disappear - it is possible that there is another cause for your symptoms - let your doctor know before you do this. If they continue, speak to your doctor about the options above.

Serious side effects of statins

The risk of very serious side effects is extremely low. It's important that you speak to your doctor if you experience any of the following:

• Rhabdomyolysis (life-threatening muscle damage) - indicated by extreme muscle pain.

• Liver damage - indicated by feeling unusually tired or weak, loss of appetite, upper tummy pain, dark-coloured pee, or yellowing of the skin or eyes.

• Inflammation of the liver (hepatitis) - indicated by flu-like symptoms.

• Inflammation of the pancreas (pancreatitis) - indicated by stomach pain.

• Peripheral neuropathy - indicated by a loss of feeling or tingling in the hands and feet.

• Statins and diabetes - there is a small but important risk that statins can raise blood sugar levels, causing type 2 diabetes.

• Statins and memory loss - there is little evidence that statins cause memory loss, but some people report temporary memory loss or confusion that reverses when they stop taking statins.