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Do statins cause rhabdomyolysis, and how is it treated?

Medically reviewed by Kristianne Hannemann, PharmD. Last updated on June 3, 2025.

Official Answer by Drugs.com

Rhabdomyolysis is a rare but serious side effect of statins, a class of cholesterol-lowering medications. It involves the breakdown of muscle tissue, which releases substances into the bloodstream that can cause kidney damage. While statins are generally safe, rhabdomyolysis from statins is uncommon and most likely to occur at high doses or when combined with certain other drugs.

What Is Rhabdomyolysis?

Rhabdomyolysis is a condition where skeletal muscle tissue breaks down rapidly, releasing intracellular contents such as myoglobin and creatine kinase (CK) into the blood. The core drug-induced rhabdomyolysis symptoms include:

Potential complications of rhabdomyolysis include acute kidney injury, electrolyte imbalances, and, in severe cases, life-threatening heart arrhythmias or compartment syndrome.

How Do Statins Cause Rhabdomyolysis?

Statin drugs and rhabdomyolysis are linked through statins’ effect on muscle cell energy production. Statins inhibit the HMG-CoA reductase enzyme, which reduces cholesterol but also decreases coenzyme Q10 (ubiquinone), an important molecule for mitochondrial energy production in muscle cells. This disruption can lead to mitochondrial toxicity and muscle cell breakdown.

The risk of rhabdomyolysis with statins increases with:

Risk Factors

Certain factors elevate the risk of rhabdomyolysis from statins:

Which Statins Pose the Highest and Lowest Risk?

The risk of rhabdomyolysis varies among statin drugs. Simvastatin, especially at high doses, has the highest risk, while pravastatin and fluvastatin—less metabolized by CYP3A4—have the lowest risk of rhabdomyolysis statin side effects. Talk with your healthcare provider about the statin that is best for you. They will weigh the risk of rhabdomyolysis against other factors, such as efficacy.

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Recognizing and Diagnosing Rhabdomyolysis

Early recognition of rhabdomyolysis is key for preventing potentially serious complications. The classic triad of rhabdomyolysis symptoms is:

However, many patients may not have all three symptoms. Diagnosis is confirmed by blood tests showing markedly elevated creatine kinase (CK) levels, increased serum myoglobin, and signs of kidney dysfunction.

Management and Treatment

Immediate steps for treating rhabdomyolysis with statins include:

In severe cases, dialysis may be required if acute kidney injury develops.

Can You Restart Statins After Rhabdomyolysis?

Restarting statin therapy after rhabdomyolysis is possible, but must be carefully considered. Strategies include:

Each case should be evaluated individually, weighing the cardiovascular benefits of statin therapy against the risk of recurrence.

Key Drug Interactions to Avoid

Certain drugs greatly increase the risk of rhabdomyolysis from statins. Medications that should be avoided during statin therapy include:

Patients should always check for drug interactions—using resources like Drugs.com’s interaction checker—before starting new medications with statins.

Summary

A potential side effect of statins is rhabdomyolysis, which involves the breakdown of muscle tissue. The risk increases with high doses, certain drug interactions, and underlying health conditions. Prompt recognition and treatment are crucial to prevent serious complications. With careful management, many patients can safely resume statin therapy using lower-risk options and close monitoring.

References
  1. Centers for Disease Control and Prevention. 2025. Signs and Symptoms of Rhabdomyolysis. Accessed on June 3, 2025 at https://www.cdc.gov/niosh/rhabdo/signs-symptoms/index.html
  2. Medsafe. 2014. Statins and CYP Interactions. Accessed on June 3, 2025 at https://www.medsafe.govt.nz/profs/PUArticles/March2014StatinsAndCYPInteractions.htm
  3. Montastruc J. L. 2023. Rhabdomyolysis and statins: A pharmacovigilance comparative study between statins. British journal of clinical pharmacology, 89(8), 2636–2638. https://doi.org/10.1111/bcp.15757
  4. Morris, R., et. al. 2025. The Association Between Statin Drugs and Rhabdomyolysis: An Analysis of FDA Adverse Event Reporting System (FAERS) Data and Transcriptomic Profiles. Genes, 16(3), 248. https://doi.org/10.3390/genes16030248
  5. Safitri, N., et. al. 2021. A Narrative Review of Statin-Induced Rhabdomyolysis: Molecular Mechanism, Risk Factors, and Management. Drug, healthcare and patient safety, 13, 211–219. https://doi.org/10.2147/DHPS.S333738
  6. Stanley, M, et. al. Updated 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed on June 3, 2025 at https://www.ncbi.nlm.nih.gov/books/NBK448168/
  7. Torres, P. A., et. al. 2015. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner journal, 15(1), 58–69. PMCID: PMC4365849  PMID: 25829882

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