Why statins cause muscle pain, and what to do about it

In this article:

• Statin-induced muscle pain
• Causes of statin muscle pain
• Who is at risk
• Which statins cause muscle pain?
• Remedies
• Alternatives
• How to save
• Bottom line
• FAQs

In this article

• Statin-induced muscle pain
• Causes of statin muscle pain
• Who is at risk
• Which statins cause muscle pain?
• Remedies
• Alternatives
• How to save
• Bottom line
• FAQs

For decades, people taking statin medications to lower their LDL cholesterol have been warned about an uncomfortable side effect: muscle pain. Up to 30% of people on statins report aches and pains, according to the Cleveland Clinic. And, until recently, scientists couldn’t really explain why.

However, new research into how statins interact with muscle cells has potentially revealed the connection, paving the way toward a better understanding of who is more likely to be affected by statin-related muscle pain and how it should be treated. Read on for more about how statins cause muscle pain and what to do if you’re experiencing this side effect with your medication.

What is statin-induced muscle pain, and where does it usually occur?

Statin-associated muscle symptoms, often broadly referred to as myalgia, are muscle aches and pains that occur as a direct result of taking a statin medication, says Michael Dosik, MD, an internist at Medical Offices of Manhattan. Patients typically report dull aches, muscle cramps, heaviness, or muscle fatigue, often in large centrally located muscles like the thighs, hips, and buttocks. This myalgia is also usually symmetrical, per Dr. Dosik; for example, you usually experience pain in both legs rather than just one.

How common is muscle pain from statins?

Although up to 30% of people taking statins experience muscle pain, recent studies suggest the medication itself may only be the cause in less than 10% of people experiencing it. In one study in The Lancet examining data from more than 150,000 people, muscle pain could only be traced back to statin medications in 1 out of every 15 people reporting symptoms.

In most cases, muscle pain is simply a common, everyday occurrence (caused by injuries, aging, or other health conditions), or may even be a result of the “nocebo effect,” where people report a symptom after taking a new medication because they’re expecting to experience it. In the Lancet study mentioned above, muscle aches and pains were common in both people taking statins and those on a placebo.

Even when statins were the cause of muscle pain, the Lancet study found that symptoms were generally mild, and most of the extra muscle pain showed up within the first year of starting treatment. Serious muscle problems, like rhabdomyolysis (a severe breakdown of muscle tissue), are rare.

Why do statins cause muscle pain? The latest discovery

While experts have known for a long time that muscle pain is a possible side effect of statins, they didn’t know much about how or why statins had this effect. That changed in late 2025, when two new studies, one in Nature Communications and one in The Journal of Clinical Investigation, discovered one way that statins may interact with muscle cells.

Based on these lab and animal studies, scientists now believe that:

1. Statins can bind to a protein called ryanodine receptor 1 (RyR1) in muscle cells. RyR1 forms a channel in muscle cells for calcium to pass through, which helps your muscles contract and move.
2. When statins bind to RyR1, they can push the calcium channel open. This forced opening can cause a calcium leak, or an overflow of calcium in the muscle cells.
3. A calcium leak can weaken muscle tissue, which may lead to the aches and pains some people feel after taking statins. People with certain variations in the RYR1 gene may be at a higher risk of muscle problems on a statin.

This discovery isn’t 100% new. It builds on existing theories about statin-related muscle pain. Previously, experts thought that statins reduced the amount of coenzyme Q10 (CoQ10) in muscle cells, which lowered energy production and increased stress in the cells (ultimately causing muscle pain, fatigue, and tissue breakdown). That theory is still plausible, and this new research adds another possible explanation, linking statins to calcium channel leaks that may weaken and damage muscle tissue.

Though more research into the relationship between statins and muscle pain is still needed, this discovery opens up opportunities to develop newer statins in the future that are less likely to cause muscle pain.

Who’s most at risk for statin muscle pain?

Even though statins don’t cause muscle pain in the majority of people taking them, it’s still a potential side effect for a small number of patients, and some people are more at risk than others. According to Dr. Dosik, statin myalgia is most common in older women with a low body mass index (BMI). Some underlying medical conditions, he adds, such as an underactive thyroid (hypothyroidism) or liver disease, can also increase your risk.

Some other things that may increase your risk for statin myalgia include:

• Taking certain statins with grapefruit juice or certain medications, like diltiazem, verapamil, amiodarone, and some antibiotics and antifungals
• Consuming alcohol heavily
• Taking higher doses without gradually increasing the dose
• Having a vitamin D deficiency (though evidence for this link is mixed)

Which statins are more or less likely to cause muscle pain?

There are two types of statins: hydrophilic and lipophilic. Both types work in the liver to lower cholesterol. Hydrophilic statins, which include rosuvastatin and pravastatin, are water-soluble, while lipophilic statins like simvastatin, atorvastatin, and lovastatin are fat-soluble.

According to Nimai Patel, MD, a cardiologist at Summit Health, lipophilic statins may be more likely to cause muscle pain because their fat-soluble nature allows them to cross cell membranes and be absorbed into tissues outside the liver. However, Dr. Patel notes that studies haven’t shown a significant difference between the two classes when it comes to statin myalgia.

What to do if a statin is causing your muscle pain

It’s tempting to stop taking any medication when it appears to be causing uncomfortable side effects, but you shouldn’t quit statins at the first sign of aches and pains. Here’s what to do instead.

Talk to your healthcare provider first

You shouldn’t stop taking any prescribed medication without consulting your healthcare provider first, including statins. Abruptly discontinuing statins increases your risk of complications from cardiovascular disease, including events like heart attack and stroke. Even if your provider ultimately recommends you stop taking your statin, it should only be done under their guidance.

Steps a healthcare provider may recommend

There are several things your provider may want to try before taking you off your statin medication. Per Dr. Patel, the first step is to determine whether the medication is actually the cause of your muscle pain. Before anything else, your provider will most likely take a thorough medical history, perform a physical exam, and may even order some lab tests, he says.

If your statin seems to be the cause, there are still a few ways to address your muscle pain without discontinuing the medication completely. Your provider may lower your dose, recommend you take your medication only every other day (an off-label use that works best with longer-acting statins like rosuvastatin and atorvastatin), or even suggest taking a short break from your statin to see if your muscle pain resolves before deciding how to move forward.

Your provider may also suggest switching to another statin. There are several statin medications, and some may affect you differently than others. For example, atorvastatin is a commonly prescribed medication, but it’s a lipophilic statin; if it’s causing muscle pain, your healthcare provider may recommend switching to a hydrophilic statin, like rosuvastatin, to see if your symptoms improve.

Lifestyle and supplement approaches

You may be able to reduce your statin-associated muscle pain with some minor lifestyle changes rather than changing your medication. Dr. Dosik says staying adequately hydrated, especially during exercise, can help by lowering your risk for muscle injury. Speaking of exercise, some research suggests that aerobic exercise may improve muscle fitness in people taking statins, so it helps to stay active. Remember to ramp up gradually, since starting a new, intense workout routine can also cause muscle soreness.

Some people find that supplementing with CoQ10 or vitamin D helps them find relief from statin-associated muscle pain, but Dr. Dosik says these results haven’t been consistent in any clinical trials. Studies on CoQ10 have had mixed results, and in one large trial, vitamin D didn’t prevent statin-related muscle pain. Talk to your healthcare provider before adding CoQ10 or vitamin D to your routine; they can determine whether these supplements are safe for you to take.

Statin alternatives for muscle pain

If your current statin medication or dose is causing muscle pain, there are other non-statin medications that can lower cholesterol and help manage your risk for heart disease, including:

• Zetia (ezetimibe)
• Nexletol (bempedoic acid)
• PCSK9 inhibitors like Repatha (evolocumab) and Praluent (alirocumab)
• Bile acid sequestrants, including Questran (cholestyramine) and Welchol (colesevelam)

Statins are the first-line treatment for lowering cholesterol, but if you’ve tried making adjustments to your medication and are still having side effects, your provider may recommend one of these alternatives. You also may be able to take a non-statin medication in addition to a lower-dose statin. This combination could relieve your side effects while still effectively lowering your cholesterol.

How to save on statins and statin alternatives

Many generic statin medications (including atorvastatin, rosuvastatin, simvastatin, and pravastatin) have been on the market for a long time, making them affordable for the majority of people taking them. But if your generic statin is still costly, you can use a SingleCare coupon to lower the retail price regardless of your insurance status.

Some of the newer alternatives to statins, like Nexletol and Repatha, cost more out of pocket than generic statins, but you may still be able to use a SingleCare coupon to lower these costs, too.

Bottom line

Muscle pain is a potential side effect of statins, but research suggests statins are the true cause in fewer than 10% of people experiencing muscle pain from statins. For those 10%, statin myalgia is usually mild, tends to show up in the first year of treatment, and rarely leads to serious muscle problems. Seek immediate medical care if you have severe muscle pain or weakness or dark urine, which may be signs of rhabdomyolysis.

If your muscle pain is interfering with your daily life, don’t stop taking your statin suddenly. Instead, contact your healthcare provider. There may be several other ways to address your statin-related pain, like switching to a different statin or lowering your dose. The good news is that new research offers more clues about how statins may cause muscle pain, which hopefully will pave the way toward better-tolerated statins in the future.

Frequently asked questions

How long does statin muscle pain last after stopping?

Most people report it takes a few days to a few weeks for their statin-associated muscle symptoms to go away after stopping the medication, per Dr. Patel. If your symptoms don’t improve within a few weeks of stopping, let your provider know so they can check for other causes.

Can you switch to a different statin if one causes muscle pain?

Yes, and this is often one of the first steps a provider takes when addressing statin myalgia. Some people tolerate certain statins better than others, Dr. Dosik says, and hydrophilic statins may be slightly less likely to cause muscle pain.

“The goal of statin therapy is to help lower a patient’s cholesterol, so the choice of statin should be done with that goal and the statin’s side effect profile in mind,” he adds.

Why did my muscle pain start weeks or months after starting a statin?

It may take longer for statin-related muscle symptoms to appear in some people. Dr. Patel says most people who experience muscle pain because of statins do so in the first 4 to 12 weeks after starting the medication or increasing the dose, but that’s not a fixed rule. Muscle symptoms can appear several months later, too. It’s also possible that your health changed in the time since starting statins; for example, you may have lost weight, started taking another medication that interacts with your statin, or developed a condition like hypothyroidism.