High cholesterol is a major risk factor for the development of heart disease and stroke. Lipids found in the bloodstream can accumulate and form clots and plaques within arterial blood vessels. In order lower cholesterol, many patients are prescribed medications in the drug class known as statins. Although often effective in the treatment of high cholesterol, patients taking statins should be routinely monitored for adverse effects.
Statins
Commonly prescribed medications in the statin drug class include simvastatin, atorvastatin, rosuvastatin, pravastatin, fluvastatin and lovastatin. These drugs work by inhibiting HMG-CoA reductase, an enzyme responsible for the production of cholesterol. Statin medications can have side effects.
Myopathy
Although the mechanism by which statins can cause muscle injury is not precisely known, it has been theorized that statins may inhibit the synthesis of enzymes and proteins vital to muscle cells. Muscle pain and weakness are symptoms of myopathy that can occur with the use of statin drugs. In severe cases, statin therapy can lead to muscle breakdown, a condition known as rhabdomyolysis. According to the simvastatin (Zocor) product package insert, the risk of myopathy and rhabdomyolysis increases with higher doses.
Liver Injury
Statin therapy has also been known to cause an elevation in liver enzymes found within the bloodstream. An increased level of the enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may indicate the presence of liver injury, since they are released into the bloodstream following the death of liver cells. Patients who are on statin therapy often require routine monitoring of liver function.
Drug Interactions
Statin medications are primarily metabolized within the liver by cytochrome P450 (CYP) enzymes. Unfortunately, many other prescription medications are also metabolized by CYP enzymes. Competition and inhibition of these enzymes by statin therapy can increase the levels of other drugs found within the body. As a result, patients may experience toxic effects of other medications that are being taken at the same time as statins. Speak with your physician if you have concerns regarding statin therapy and interactions with other medications.
References
- Merck: (ZOCOR TM) Product Package Insert
- "The Journal of the American Medical Association"; Statin-Associated Myopathy; Paul D. Thompson, MD; Priscilla Clarkson, PhD; Richard H. Karas, MD, PhD; April 2003.
- Lab Tests Online: Liver Disease
