What are the potential side effects of statins that I should discuss with my patients?

When discussing statins with your patients, you should inform them about the potential side effects, which primarily include muscle symptoms such as pain, tenderness, or weakness. These muscle-related adverse effects are generally uncommon, and the risk of severe muscle damage (rhabdomyolysis) is extremely low. Patients should be advised to seek medical advice if they experience unexplained muscle symptoms while on statins.

Other potential side effects include elevated liver transaminase levels, although mild elevations (less than 3 times the upper limit of normal) do not usually require stopping treatment. Patients should be informed about possible drug interactions, including with certain foods like grapefruit juice, which can increase the risk of adverse effects.

It is also important to note that statins can slightly increase blood glucose levels or HbA1c, but this should not lead to withholding treatment. Statins are contraindicated in pregnancy and should be stopped 3 months before attempting to conceive and during breastfeeding.

If patients report adverse effects, strategies include stopping and rechallenging the statin, switching to a different statin within the same intensity group, reducing the dose, or using a lower-intensity statin. For those intolerant to daily dosing, alternate-day or twice-weekly regimens with statins that have longer half-lives (e.g., atorvastatin, rosuvastatin) may be considered.