Can Crestor (rosuvastatin) cause muscle spasms?

Does Crestor Cause Muscle Spasms?

Yes, Crestor (rosuvastatin) can cause muscle spasms and other muscle-related symptoms as part of statin-associated side effects. 1 Muscle symptoms are among the most common adverse effects reported with statin therapy, including Crestor, affecting approximately 5-20% of patients taking statins in clinical practice 2.

Types of Muscle Symptoms Associated with Crestor

Muscle-related symptoms that can occur with Crestor include:

• Muscle spasms and cramps
• Muscle pain (myalgia)
• Muscle tenderness
• Muscle stiffness
• Muscle weakness
• Fatigue

According to the FDA drug label for rosuvastatin, these muscle problems can range from mild discomfort to severe conditions in rare cases 1. The drug label specifically lists "muscle aches and pains" among the most common side effects of rosuvastatin.

Frequency and Severity

The prevalence of muscle symptoms varies across different studies:

• In real-world settings, approximately 10% of statin-treated patients report muscle symptoms 3
• A cross-sectional study found muscle pain prevalence as high as 73.5% among statin users 4
• However, a large meta-analysis of randomized controlled trials found only a small excess of muscle symptoms with statin therapy compared to placebo (RR 1.03; 95% CI 1.01-1.06) 5

Risk Factors for Muscle Symptoms with Crestor

Several factors increase the risk of developing muscle symptoms with rosuvastatin:

• Age ≥65 years
• Female sex
• Small body frame and frailty
• Uncontrolled hypothyroidism
• Renal impairment
• Higher rosuvastatin doses
• Asian ethnicity
• Drug interactions with medications that share metabolism pathways
• Perioperative periods
• Vitamin D deficiency 2, 1

Management of Muscle Symptoms

If a patient experiences muscle symptoms while taking Crestor, the ACC/AHA guidelines recommend the following approach 2:

1. For mild to moderate symptoms:

   • Temporarily discontinue the statin until symptoms can be evaluated
   • Check CK levels and compare to baseline
   • Rule out other causes (hypothyroidism, vitamin D deficiency, recent exercise, etc.)
   • If symptoms resolve, consider rechallenge with the same statin at original or lower dose
   • If symptoms recur, try a different statin at a low dose
   • Gradually increase the dose as tolerated

2. For severe symptoms or significantly elevated CK:

   • Promptly discontinue the statin
   • Evaluate for rhabdomyolysis (check CK, creatinine, urinalysis)
   • Consider alternative lipid-lowering therapies if appropriate

Important Clinical Considerations

• The nocebo effect may contribute to muscle symptoms in some patients. In the SAMSON trial, 90% of adverse symptoms experienced with statins were also experienced with placebo 2
• True statin intolerance is uncommon, and many patients can tolerate an alternative statin or dosing regimen
• Muscle symptoms typically affect large proximal muscle groups and are usually symmetric 2
• Muscle symptoms may appear at any time during treatment 2
• In rare cases, statins including Crestor can cause immune-mediated necrotizing myopathy (IMNM), a serious autoimmune condition requiring immunosuppressive treatment 1

Conclusion

While Crestor can cause muscle spasms and other muscle symptoms, the benefits of statin therapy in reducing cardiovascular events generally outweigh this risk for most patients. A systematic approach to evaluating and managing muscle symptoms can help maintain patients on appropriate lipid-lowering therapy while minimizing discomfort.