What statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) have low side effects?

From the Guidelines

Rosuvastatin and pravastatin are generally considered to have lower side effect profiles among statins. These medications are preferred due to their pharmacokinetic properties, which reduce the likelihood of interactions with other medications and minimize the risk of muscle-related side effects and cognitive complaints.

Key Points to Consider

• Rosuvastatin (Crestor) is more potent at lower doses (5-10mg daily) and is less likely to interact with other medications because it's not extensively metabolized by the cytochrome P450 system 1.
• Pravastatin (Pravachol, typically 20-40mg daily) is hydrophilic, meaning it doesn't cross into the brain and other tissues as readily as lipophilic statins, potentially resulting in fewer muscle-related side effects and cognitive complaints 1.
• Both medications are taken once daily, usually in the evening.
• When starting any statin, it's advisable to begin at a lower dose and gradually increase if needed while monitoring for side effects.
• Common statin side effects include muscle pain, liver enzyme elevations, and rarely, memory issues or increased blood sugar 1.
• The lower side effect profile of these statins relates to their pharmacokinetic properties - how they're absorbed, distributed, and eliminated from the body.
• If side effects occur with one statin, switching to another with different properties often resolves the issue.
• Regular monitoring of liver enzymes and reporting any muscle pain to your healthcare provider is important when taking any statin medication.

Statin-Associated Side Effects

Some statins are associated with side effects such as muscle pain, liver enzyme elevations, and increased risk of new-onset diabetes mellitus 1. However, rosuvastatin and pravastatin have been shown to have a lower risk of these side effects compared to other statins.

Important Considerations

• A comprehensive evaluation of musculoskeletal symptoms is recommended before initiating lipid-lowering therapy with a statin 1.
• Identifying predisposing factors for statin-associated muscle symptoms, including demographics, comorbid conditions, and use of medications that can adversely affect statin metabolism, is crucial 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Statins with Low Side Effects

• Pravastatin has been shown to have low side effects in several studies, including the GISSI Prevenzione trial 2 and the Pravastatin Anti-atherosclerosis Trial in the Elderly (PATE) 3.
• Pitavastatin has also been found to have a favorable safety profile, with no significant difference in adverse event rates compared to atorvastatin and rosuvastatin in the PATROL trial 4.
• A review of the safety of statins found that myalgia is the most common side effect, but rhabdomyolysis is rare, and pitavastatin has not been associated with an increased risk of diabetes 5.
• Low-dose pravastatin (10 mg) has been shown to be safe and effective in reducing plasma total and LDL-cholesterol in hypercholesterolemic, hypertensive elderly patients 6.

Comparison of Statins

• The PATROL trial compared the safety and efficacy of pitavastatin, atorvastatin, and rosuvastatin, and found that they were equal in terms of safety and efficacy 4.
• The PATE trial compared low-dose (5 mg) and standard-dose (10-20 mg) pravastatin, and found that standard-dose pravastatin was more effective in reducing the incidence of cardiovascular events in the elderly 3.

Safety Considerations

• The most common risk factors for statin-related myopathy include hypothyroidism, polypharmacy, and alcohol abuse 5.
• Statins have not been proven to increase the risk of malignancy, dementia, mood disorders, or acute interstitial nephritis, but may have multiple drug interactions, primarily with the cytochrome p450 enzyme group 5.