High cholesterol and statins: common questions when you start

What time to take your statin, which side effects to watch for, what about grapefruit and alcohol, and why you should not stop it on your own.

If you have just started on a statin, the essentials are to take it every day at the time stated in its leaflet, not to stop it even if you feel well, and to talk to your doctor if you notice muscle pain or weakness with no obvious cause. Most people take it for years without problems.

It is normal to have questions at first: whether it is for life, whether it causes aches, whether you can still have grapefruit. Here we answer the most common ones with what the official leaflets say.

What is a statin for and how long will I need to take it?

Statins lower LDL cholesterol (the so-called "bad cholesterol") and, with it, the risk of heart attack and stroke. They are usually taken long term: the NHS explains that if you stop taking them, your cholesterol levels may go back up, and advises talking to your doctor or pharmacist first.

Not feeling anything does not mean they are not working. High cholesterol has no symptoms, and the statin works quietly; that is why your doctor will ask for check-up blood tests to see the effect and adjust the dose if needed. A statin does not replace diet, exercise or stopping smoking: they work together.

What time should I take my statin?

It depends on which one you have been prescribed. Atorvastatin can be taken at any time of day, with or without food, as long as it is always at the same time; simvastatin, on the other hand, is taken in the evening according to its leaflet. For any other statin, follow its leaflet or ask your pharmacy.

Linking the dose to a fixed habit, such as brushing your teeth at night, helps a lot. You will find more ideas in how to link each dose to a daily habit.

Which side effects are common and when should I seek advice?

Most people take statins without problems, but side effects such as headache, feeling sick, bowel changes, tiredness, sleep problems or muscle pain can occur. If you notice unexplained muscle pain, tenderness or weakness, the simvastatin leaflet asks you to contact your doctor straight away.

• Seek advice promptly if you have severe muscle weakness or pain, especially with fever, feeling unwell or reddish-brown urine.
• Mention mild symptoms that do not go away at your next appointment: your doctor may switch statin or adjust the dose.
• Your doctor may ask for check-up blood tests; the atorvastatin leaflet also says they will monitor your blood sugar if you are at risk of diabetes.
• Do not take statins if you are pregnant or trying to get pregnant, as the atorvastatin leaflet states.

If you are not sure whether a symptom comes from your medication, our article on how to tell if a new medicine disagrees with you may help. What you should not do is stop your statin on your own.

Can I have grapefruit, alcohol or other medicines with my statin?

Grapefruit and some medicine combinations can increase the amount of statin in your blood and, with it, the risk of side effects. The atorvastatin leaflet says not to drink more than one or two small glasses of grapefruit juice a day, and the simvastatin leaflet says to avoid it.

• Alcohol: the atorvastatin leaflet asks you to avoid drinking a lot of alcohol. There is more in alcohol and medication.
• Other medicines: some antibiotics (such as clarithromycin or erythromycin), several antifungals, ciclosporin, gemfibrozil or colchicine, among others, are listed in the atorvastatin leaflet as medicines that may interact.
• Herbal remedies and supplements: St John's wort is also listed in the leaflet. Mention any natural product you take.

Whenever you are prescribed something new, remember to say that you take a statin, including in A&E or at the dentist.

A practical example: Luis starts atorvastatin

Take the case of Luis, 55, a teacher with high cholesterol and a family history of heart attack. His GP prescribes atorvastatin and asks him to have a check-up blood test later on. Luis goes running three times a week and is worried about the muscle pain he has heard about.

1. He chooses to take the tablet with his evening meal, every day at the same time, and sets an alarm for the first few weeks.
2. As he has grapefruit juice at breakfast, he asks at the pharmacy: they remind him that the leaflet allows one or two small glasses a day at most.
3. After a month his legs feel heavy after running. As the pain is not severe and his urine is not dark, he notes it down and mentions it to his GP.
4. His GP assesses it with the check-up blood test and decides how to proceed. Luis does not stop the tablet on his own.

Knowing what is normal and what is not lets him get on with his life and his running with peace of mind.

How can IMA Health help if you take a statin and other medicines?

A statin is often added to other treatments, such as those for blood pressure or diabetes. At IMA Health we coordinate with a specialised pharmacy that prepares all your medication by day and time of each dose, we deliver it to your home and we provide personalised follow-up so you can raise questions or changes.

If you take several medicines, you may find our article on how to organise yourself with six medicines a day useful.

Sources

• CIMA (AEMPS): Atorvastatina Cinfa 10 mg package leaflet (in Spanish)
• CIMA (AEMPS): Simvastatina Cinfamed 20 mg package leaflet (in Spanish)
• NHS: Statins

This article is for information only and does not replace advice from your doctor or pharmacist.