Statins help reduce unhealthy cholesterol levels in your bloodstream. The statin that a doctor recommends for you can depend on your cholesterol level and health, as well as other medications you take.

Statins are a class of medication also known as HMG CoA reductase inhibitors. They help reduce high levels of low-density lipoprotein (LDL) cholesterol, also referred to as “bad” cholesterol, in your bloodstream.

LDL cholesterol is a waxy, fatty substance that sticks to the blood vessels of your heart and the walls of your arteries. This can make your arteries harden or form plaques that block or reduce blood flow.

Statins mainly work by reducing your body’s ability to make LDL cholesterol. They may also help raise “good” high-density lipoprotein (HDL) cholesterol and lower blood triglycerides.

Doctors commonly prescribe statins for high cholesterol, with 92 million people in the United States reporting taking statins in 2019. Taking statins can dramatically reduce your risk of cardiovascular disease, such as atherosclerosis and heart attack. As with all medications, some people may experience side effects.

Keep reading to learn more about the safety and possible side effects of statin therapy and which medications may work best for you.

Statins are safe for the majority of people. In fact, the American Heart Association (AHA) notes that the benefits of statin therapy greatly outweigh the low risks associated with taking them.

Doctors may recommend specific statin medications if you have certain medical conditions. This is because some types may interact with other medications you may be taking. It’s best to talk with a doctor about the risks and benefits of statin therapy and possible drug interactions.

Statins approved for use the in United States include:

The specific medication a doctor recommends for you can depend on your cholesterol levels and other personal factors.

The amount, or dose, needed for a statin to be effective is also a factor in which medication a doctor will prescribe for you. Lower doses of most statins reduce the risk of side effects.

According to research from 2016, pravastatin (Pravachol) may have fewer side effects affecting the muscles than other statins. Other well-tolerated statins include simvastatin (Zocor) and fluvastatin (Lescol).

If you take azole antifungal medication

Azole antifungal meds are often prescribed for fungal infections such as thrush and vaginal yeast infections.

Experts recommend not combining the antifungal medications itraconazole (Sporanox) and ketoconazole (Xolegel, Extina, Nizoral) with certain statins, as this can increase the chance of toxicity. These include:

  • atorvastatin (Lipitor)
  • lovastatin (Mevacor, Altoprev)
  • simvastatin (Zocor)

If you take protease inhibitors

If you take protease inhibitors like atazanavir (Reyataz), ritonavir (Norvir), or lopinavir/ritonavir (Kaletra) to treat HIV, you may need to avoid or have additional monitoring while taking:

  • lovastatin (Mevacor, Altoprev)
  • pitavastatin (Livalo)
  • simvastatin (Zocor)
  • rosuvastatin calcium (Crestor)
  • atorvastatin (Lipitor)

Research from 2023 suggests that pravastatin (Pravachol) and fluvastatin (Lescol) are less likely to interact with protease inhibitors than other options.

If you take macrolide antibiotics

If you are taking macrolide antibiotics for bacterial infections, you may need to avoid lovastatin (Mevacor, Altoprev) and simvastatin (Zocor).

If you take atorvastatin or pitavastatin, you may need a dosage adjustment by a healthcare professional.

If you take cyclosporine

Cyclosporine (Gengraf, Neoral, Sandimmune) is prescribed to treat a number of conditions, including psoriasis and rheumatoid arthritis. It’s also used to prevent organ rejection after transplants.

Experts recommend avoiding lovastatin (Mevacor, Altoprev) and pitavastatin (Livalo) if you are taking cyclosporine.

If you’re taking cyclosporine, a healthcare professional may need to adjust your dosage with other statins.

Statins are usually well tolerated. That means that many people do not have bothersome side effects when taking them.

Common minor side effects may include:

  • diarrhea
  • constipation
  • rash
  • headache

Any medication, including statins, can potentially cause an allergic reaction. Symptoms of an allergic reaction to medication typically include an itchy rash.

Though rare, medications can also cause anaphylaxis, which is a medical emergency. Get emergency medical attention if you have:

  • swelling of the lips, face, or airways
  • difficulty breathing or swallowing
  • confusion
  • fainting
  • swollen, peeling, or blistered rash

Liver inflammation

In a small number of people, statins increase the enzymes the liver uses to help digestion. This can cause the liver to become inflamed, which may lead to damage. Symptoms of liver issues may include:

  • fatigue
  • jaundice (yellowing of the skin and eyes)
  • tea-colored urine

Muscle inflammation and pain

Statins can potentially affect the muscles, causing:

  • aches
  • pain
  • weakness

Very rarely, a condition called rhabdomyolysis can occur. This severe side effect results in damage to the muscles. It most commonly affects people with other risk factors for the disorder, which could include:

  • reduced thyroid function
  • liver disease
  • slower kidney function

Cognitive concerns

Though rare, some people may experience problems with memory and concentration while taking certain statin medications. These symptoms are not serious and can be reversed when stopping statins or switching to a different statin.

Diabetes risk

You may have a minimal risk of developing newly diagnosed type II diabetes while on statin therapy. This side effect mostly commonly affects people who already have an increased risk of type II diabetes. This can include people with metabolic syndrome and prediabetes. It is not clear how statins increase the risk.

The AHA notes that this risk is very small compared with the number of cardiovascular diseases that statins prevent. Diabetes is a major risk factor for atherosclerotic cardiovascular disease, which statins help prevent.

Doctors commonly recommend statins to people with diabetes who are at risk of or have cardiovascular disease.

Kidney risk

If you have kidney disease, you may need a lower dose of statins. Some statin doses may be too high for people with kidney disease.

You are pregnant or breastfeeding

Experts recommend not taking statins if you are pregnant or breastfeeding.

The benefit you gain from statins depends on the level of risk you have for cardiovascular disease. But generally, the latest guidelines recommend statins for people who have high cholesterol. Untreated, high cholesterol increases the risk of cardiovascular disease, including heart attack and stroke.

You can talk with a doctor about reducing your cholesterol with diet and exercise.

If diet and exercise aren’t enough, you can discuss which statin is best for you given your level of risk, other medical conditions you may have, and medications you take.

Doctors may recommend alternate treatment for people who cannot take statins, whether due to an allergy or drug interaction.