Cholesterol is a fatty, waxy substance that the body needs for normal function. However, too much cholesterol results in the buildup of cholesterol on the walls of arteries throughout the body, resulting in an increased risk for heart problems. Abnormally high cholesterol is called hypercholesterolemia, and may be treated with lifestyle changes, such as exercise and diet; or with a variety of medications. As with all medications, cholesterol-lowering medications may result in unwanted, potential dangerous, side effects.
Muscle Toxicity
Myopathy, or muscle damage, is a known side effect of several different types of cholesterol-lowering medications. One class of medications in which this is especially common is known as fibric acid derivatives, or fibrates. These medicines act by lowering levels of fats in the bloodstream -- triglycerides -- as well as lowering the LDL, or bad cholesterol levels. In addition, fibrates can increase the levels of HDL, or "good" cholesterol, in the bloodstream. Another class of cholesterol-lowering drugs associated with muscle damage is known as statins. These medications work by inhibiting an important enzyme in cholesterol synthesis. Without the enzyme called HMG CoA reductase, cholesterol cannot be made. According to Dr. Robert Rosenson, writing in the medical reference UpToDate, combining a statin medication with a fibrate medication increases the risk for this side effect. Symptoms indicating that muscle damage is occurring include muscle pain, muscle weakness and difficulty walking, due either to the pain or the weakness in the muscles.
Flushing
Flushing, or unusual redness of the face, may seem like a harmless side effect. However, according to Dr. Robert Rosenson, in UpToDate, this is a side effect that isn't well-tolerated by patients. Unfortunately, it is a common effect in patients taking the cholesterol-lowering medication niacin, also known as nicotinic acid. Dr. Rosenson reports that this unpleasant effect occurs in up to 80 percent of patients on niacin. Besides niacin, the statin medications -- which include atorvastatin and fluvastatin -- may also result in this side effect. Patients who are experiencing this side effect and consider it to be too uncomfortable to ignore may benefit from talking with their healthcare provider and switching to another cholesterol-lowering medication.
Elevated Liver Enzymes
Interestingly, a side effect that many cholesterol-lowering medicines have in common is the potential for raising, at least temporarily, the levels of liver enzymes that are produced by the liver. According to UpToDate, the statins may result in transient elevations in the enzymes called aminotransferases. In rare cases, these elevations are persistent. The cholesterol-lowering medication niacin is also associated with these enzymes rising. Fibric acid derivatives, such as gemfibrozil, may also cause this side effect. The concern with elevated liver enzymes is that a chronic elevation can lead to liver damage or even liver failure. Because of this, patients taking cholesterol-lowering should have periodic blood tests to measure their levels of liver enzymes and ensure that these levels are within normal range.
References
- Medline Plus: Cholesterol
- "UpToDate;" Treatment of Lipids (Including Hypercholesterolemia) in Secondary Prevention; R. Rosenson; February 2010
- "UpToDate; Lipid Lowering With Fibric Acid Derivatives; R. Rosenson; June 2010
- Medline Plus: Gemfibrozil
- "UpToDate;" Lipid Lowering With Drugs Other than Statins and Fibrates; R. Rosenson; February 2010
