Can Crestor (rosuvastatin) cause tremors in an adult patient with a history of hypercholesterolemia or cardiovascular disease?

Can Crestor Cause Tremor?

Tremor is not a recognized or documented adverse effect of Crestor (rosuvastatin) in major clinical guidelines or FDA labeling, though peripheral neuropathy with symptoms including tremor has been reported in research studies of long-term statin users.

Documented Neurological Side Effects

The established neurological adverse effects of rosuvastatin focus primarily on muscle-related symptoms rather than tremor:

• Muscle symptoms (myalgia, weakness, cramping, stiffness) are the most common neuromuscular adverse effects, occurring in clinical trials at rates similar to placebo 1
• Confusional states or memory impairment may occur and warrant evaluation for other causes before attributing to statin therapy 1
• Peripheral polyneuropathy has been documented in research studies, with one study finding polyneuropathy in 66% of long-term statin users (>1 year), with symptoms including tingling, numbness, pain, and tremor in the hands and feet 2

Evidence for Tremor as a Side Effect

The only direct evidence linking rosuvastatin to tremor comes from a single research study examining peripheral neuropathy:

• A 2019 study found that neurological symptoms including tremor in the hands and feet were associated with peripheral neuropathy in patients on long-term statin treatment 2
• This tremor appears to be a manifestation of peripheral nerve damage rather than a direct pharmacological effect 2
• The severity increased with duration of treatment, particularly beyond 1 year 2

However, tremor is not mentioned in the 2013 or 2018 ACC/AHA cholesterol guidelines as a recognized statin adverse effect 1, and the most common adverse events in the JUPITER trial were myalgia, arthralgia, constipation, and nausea—not tremor 3.

Clinical Approach if Tremor Occurs

If a patient on rosuvastatin develops tremor, the evaluation should follow this algorithm:

Step 1: Rule Out Other Causes

• Evaluate for essential tremor, Parkinson's disease, hyperthyroidism, medication interactions, caffeine excess, and anxiety before attributing to rosuvastatin 1
• Check thyroid function (TSH), as hypothyroidism increases myopathy risk but hyperthyroidism causes tremor 1, 4
• Review all medications for drug interactions, particularly CYP3A4 inhibitors 5

Step 2: Assess for Peripheral Neuropathy

• Perform a detailed neurological examination looking for tingling, numbness, pain, and unsteadiness during walking 2
• Consider electroneuromyography (ENMG) if peripheral neuropathy is suspected, particularly in patients on statins >1 year 2

Step 3: Establish Causality

• Temporarily discontinue rosuvastatin and monitor for symptom resolution over 2-4 weeks 5, 6
• If tremor resolves completely, consider rechallenge with a different statin (pravastatin, fluvastatin, or pitavastatin) that has different metabolic pathways 5, 6

Step 4: Alternative Management

• If tremor recurs with rechallenge, permanently discontinue statin therapy and consider non-statin alternatives (ezetimibe, PCSK9 inhibitors, bempedoic acid) 5, 6
• Pitavastatin is the preferred alternative statin with superior tolerability and minimal CYP3A4 dependence 5, 6

Important Caveats

• The vast majority of symptoms attributed to statins are actually nocebo effects, with the SAMSON trial showing 90% of adverse symptoms occur equally with placebo 6
• True statin intolerance is uncommon (only 1% of patients) 5, 6
• Rosuvastatin is generally well-tolerated, with most adverse events being mild to moderate 3, 7
• Early detection of peripheral neuropathy and changing treatment may prevent permanent nerve damage 2