Severe Muscle Pain from Crestor?

Jay Ara · Jun 24, 2025

I'm using 5mg Crestor for more than 6 months now. At the beginning I was having some pain but it went away after a little while. My numbers are looking good and I do not feel any side effect. Maybe consider to reduce your dosage from 10 to 5? Good luck

Jay Ara · Jun 24, 2025

SkyWarn said:
EXACTLY! I was having trouble walking and standing, my legs hurt so much. I stopped the 10mg Crestor 2 days ago and already feel much better. Will ask for a different statin.
So what was your solution? Are you under a different statin?

Maybe try to reduce to 5mg. We all know that taking testosterone will increase our bad cholesterol and there is not much you can do with diet, it may be genetical too, anyway, just my humble opinion that maybe a lower dose may work for you the same way that works for me.

Nelson Vergel · Jun 24, 2025

SkyWarn said:
. Has anyone found a good workaround to this kind of thing? Any statins that don't have the muscle pain side effect?

Get your CPK level tested. If high, your doctor can justify a prescription for Repatha due to "statin intolerance".

$24 : CPK Blood Test (Creatine Phosphokinase) | Discounted Labs

Repatha (Evolocumab) Prescription in Statin-Intolerant Patients with High CPK
Background
Statin intolerance, particularly due to muscle-related side effects such as myalgia, myopathy, or rhabdomyolysis, is a significant clinical challenge. Elevated creatine phosphokinase (CPK) levels are a marker of muscle injury and often prompt discontinuation of statin therapy. For patients who cannot tolerate statins, alternative lipid-lowering strategies are required to manage cardiovascular risk.
Efficacy and Safety of Repatha (Evolocumab) in Statin-Intolerant Patients
Repatha (evolocumab), a PCSK9 inhibitor, has been extensively studied as an alternative for patients unable to tolerate statins due to muscle-related side effects and elevated CPK levels:
· Efficacy: Evolocumab significantly lowers LDL cholesterol (LDL-C) in statin-intolerant patients. In the GAUSS-3 trial, evolocumab reduced LDL-C by approximately 53% at 24 weeks, compared to only 17% with ezetimibe, another non-statin option[1][2][3].
· Tolerability: In patients with documented statin intolerance, evolocumab demonstrated a low discontinuation rate due to muscle symptoms (0.7%), much lower than that observed with ezetimibe[1][2].
· CPK Levels: A dedicated safety analysis in patients with markedly elevated CPK (>1,000 U/L) showed that treatment with PCSK9 inhibitors (including evolocumab) was associated with a reduction in CPK in 92% of patients, and normalization of CPK in nearly half. No serious adverse reactions or significant muscle-related events were reported, and only two patients discontinued therapy (neither due to muscle symptoms or CPK elevation)[4][5][6].
· LDL-C Target Achievement: In this high-risk group, 65% achieved LDL-C <70 mg/dL and 46% achieved <55 mg/dL, demonstrating robust lipid-lowering efficacy[4][5][6].
Clinical Considerations
· Patient Selection: PCSK9 inhibitors are indicated for patients with statin intolerance, defined as inability to tolerate at least two different statins (one at the lowest dose), due to muscle symptoms or abnormal labs (such as high CPK) that resolve upon discontinuation and recur upon rechallenge[7].
· Workup: Before attributing elevated CPK solely to statins, other causes (e.g., hypothyroidism, renal failure, rheumatologic disease, intense exercise, genetic muscle disorders) should be excluded[4][6].
· Monitoring: Patients starting PCSK9 inhibitors should be monitored for efficacy (LDL-C reduction) and safety (muscle symptoms, CPK levels), though the risk of muscle injury is low[4][5][6].
Summary Table: Key Findings

Parameter	Statins (in intolerant patients)	Evolocumab (Repatha)
Muscle symptoms	Common, often severe	Rare (0.7% discontinued)
CPK elevation	Frequent, may be marked	CPK usually decreases
LDL-C reduction	Not achievable due to intolerance	~53% at 24 weeks
Serious adverse events	Risk if continued despite symptoms	None reported in studies

Conclusion
For patients intolerant to statins due to high CPK levels, Repatha (evolocumab) is a safe, effective, and well-tolerated alternative for lowering LDL cholesterol. It rarely causes muscle-related side effects or further CPK elevation, and often leads to normalization of CPK. Careful patient selection and monitoring are recommended, and secondary causes of CPK elevation should be considered and managed as appropriate[4][1][5][2][6].

1. https://www.nature.com/articles/nrcardio.2016.72
2. https://www.amgen.com/newsroom/press-releases/2016/04/positive-efficacy-and-tolerability-study-of-repatha-evolocumab-in-statinintolerant-patients-published-in-journal-of-the-american-medical-association
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC5761646/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC8446829/
5. https://e-century.us/files/ajbr/11/4/ajbr0136204.pdf
6. https://pubmed.ncbi.nlm.nih.gov/34540348/

7. https://pmc.ncbi.nlm.nih.gov/articles/PMC10125408/

Melody68 · Jun 24, 2025

Jay Ara said:
Maybe try to reduce to 5mg. We all know that taking testosterone will increase our bad cholesterol and there is not much you can do with diet, it may be genetical too, anyway, just my humble opinion that maybe a lower dose may work for you the same way that works for me.

Agree. Smaller doses of statins maintain close to the effectiveness of the larger dose while often reducing the exposure to negative side effects dramatically. I always made it a point to try 1/2 of the prescribed statin dose before going to the full dose, with excellent results. When it comes to prescription drugs, always take the smallest dose that gets the job done.

Guided_by_Voices · Jun 25, 2025

Melody68 said:
I'm 68, had some severe heart disease at a younger age, blood profile was terrible, had a heart bypass at 56. I've been through the whole statin merry-go-round. I experimented a lot. Lots of side effects and nothing seemed to address all my blood factors. In addition I had a very high Lp(a) that most doctors don't even know about or address.

I found high dose niacin (vitamin B3, the real stuff, not that "no-flush" nonsense), which resulted in outstanding correction of blood measurements, so much so that the cardiologists were baffled and frankly, didn't believe me when I told them that it was all due to niacin. There is a book by Dr. Parsons, "Cholesterol Control Without Diet"; it made all the difference in my life, I've been taking it for 22 years. It's used extensively in Europe, it's dirt cheap, I buy it at the vitamin store. My son is a physician, he takes it, and was surprised to learn that other doctors he respects also place high value in it.

Some people take it the first time, get an uncomfortable 20 minute flush, then quit. The flush typically goes away in a few days and otherwise I have never felt any side effects.

I have found that the 250mg version doesn't have even 1 quarter of the flush off the 500 version, so I have switched to taking more of the 250's.