Prolonged Muscle Pain after Stopping a Statin

Muscle pain, and much less often muscle weakness, is a common side effect of taking the cholesterol-lowering statin drugs. The cause of the muscle symptoms is unclear and most commonly the pain disappears soon after stopping the drug. I have assumed that some other problem is responsible for the muscle pain if it persists after discontinuing statin use--but that may not be the case.

Persistence of muscle pain may be more common than previously recognized

A letter last year to the editor of the New England Journal of Medicine described a French study which found that muscle pain was still present in 11 of 36 patients six months after they had stopped taking a variety of different stations. 

Prolonged pain may be due to an autoimmune reaction

An article in the journal Arthritis and Rheumatism by researchers at Johns Hopkins recently described the presence of an auto-immune reaction in patients who had persistent muscle pain after statin treatment was stopped. Statins work by inhibiting the activity of the enzyme HMGCoA reductase (HMGCR). The body tries to overcome this inhibition by increasing the production of the enzyme. The antibodies are formed in response to these excessive amounts of HMGCR. The antibodies cause muscle destruction and pain by attacking the HMGCR in muscles. They found that 45 of 750 patients taking a statin had antibodies against HMGCR in their blood.

What can be done for statin-induced muscle pain or weakness?

The first step: discontinue the statin and measure blood levels of CK, an enzyme released by injured muscle cells. If CK levels are less than 1,000 and the muscle symptoms go away, treatment can be restarted with the same or a different statin. For persistent pain some doctors have prescribed coenzyme Q10, a substance that is found in muscle and is produced in lower amounts when statins block the activity of HNGCR. Blood levels of Q10 fall during statin use and can be raised by taking Q10 supplements, but studies have shown inconsistent pain relief from taking Q10 supplements.

One study found that immunosuppressant drugs like cortisone improved muscle strength in people with severe weakness caused by an auto-immune reaction to statin therapy. Immunosuppressant treatment may likewise overcome the muscle pain that persists after stopping a stain, but there aren’t yet any reports describing the effects of such treatment.