Greetings, Dr. Roach For years, I, a 74-year-old lady, have been taking 40 mg of atorvastatin. I began to feel exhausted all the time within the last year or two. Though I did occasionally experience energy bursts, most of the time it felt like an effort.
This last year, it got so bad that I avoided doing anything that required a lot of work. Meetings and get-togethers with friends would be canceled due to the effort. Even though I was napping for a few hours and getting up to 12 hours of sleep every night, I was still feeling quite tired. My doctor advised me to stop taking atorvastatin for a week and report back to her after I told her how exhausted I felt all the time.
I was bouncing around like the energizer bunny in just one day! She instructed me to take half of a tab rather than a whole one after I reported back to her for a week. This worked for a few months before I began to revert to that exhausted state. After a few weeks, I had virtually no energy left and was once again sleeping for extended periods of time and avoiding social situations since the mere notion of combing my hair made me want to cry.
When I spoke with my doctor once more, she advised me to stop using it altogether. Once more, I felt energized by the next day. I am aware that this is a crucial drug, and my investigation shows that there aren’t many substitutes. What recommendations do you have? — H.W.
ANSWER: Pharmacological effects or the expectation that a drug would create a side effect (known as the nocebo effect) can both result in adverse effects from pharmaceuticals. It may be impossible to identify the cause of the negative effect in any one person.
The fact that this effect manifested after years of taking the drug is a little strange. Adverse effects of both kinds typically occur shortly after beginning the medicine.
However, atorvastatin can definitely make you tired. Even if “enervation” is a great phrase to describe it, between 1% and 4% of atorvastatin users report feeling exhausted. This negative effect is more common in women. I typically attempt a different kind of statin medication when I observe this in my patients.
Since atorvastatin is a lipophilic statin, it can readily pass across the blood-brain barrier and enter cells and the brain. Many medications are kept out of the central nervous system by the blood-brain barrier, which is a network of tight connections inside the cells that surround the blood vessels and support brain cells. Compared to hydrophilic statins, such as rosuvastatin, which are difficult to penetrate the brain, lipophilic statins have a far higher chance of affecting brain function.
I usually advise against taking any statins for at least two weeks before starting a new one. Although pravastatin is another hydrophilic statin, I prefer rosuvastatin because it is very effective and affordable.
You should stop taking atorvastatin, in my opinion, and switching to a different statin will probably stop this dangerous side effect. Bempedoic acid is one non-statin medication that can lower the risk of heart disease if the following type of statin also causes this.
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