Major * Type 2 diabetes mellitus is observed in a small number of patients, and is an uncommon class effect of all statins. However, the benefits of statin therapy in preventing fatal and non-fatal stroke, fatal coronary heart disease, and non-fatal myocardial infarction are significant. For most patients the benefits of statin therapy far outweigh the risk of developing diabetes mellitus. A 2010 meta-analysis demonstrated that every 255 patients treated with a statin for 4 years – produced a reduction of 5.4 major coronary events and induced only one new case of diabetes mellitus. * Myopathy with elevation of creatine kinase (CK, aka CPK) and rhabdomyolysis are the most serious side effects, occurring rarely at a rate of 2.3 to 9.1 per 10,000 person-years among people taking<unk> . As mentioned previously,<unk>  should be discontinued immediately if this occurs. * Persistent liver enzyme abnormalities (elevations in hepatic transaminases) have been documented. Elevations threefold greater than normal were recorded in 0.5% of people treated with<unk>  10 mg-80 mg rather than placebo. It is recommended that hepatic function be assessed with laboratory tests before beginning<unk>  treatment and repeated as clinically indicated thereafter. If evidence of serious liver injury occurs while a person is taking<unk> , it should be discontinued and not restarted until the etiology of the person's liver dysfunction is defined. If no other cause is found,<unk>  should be discontinued permanently. Common The following have been shown to occur in 1–10% of people taking<unk>  in clinical trials: * Joint pain * Loose stools * Indigestion * Muscle pain * Nausea * Hyperglycemia High-dose<unk>  has also been associated with worsening blood sugar control. Other Cognitive There have been rare reports of reversible memory loss and confusion with all statins, including<unk> ; however, there has not been enough evidence to associate statin use with cognitive impairment, and the risks for cognition are likely outweighed by the beneficial effects of adherence to statin therapy on cardiovascular and cerebrovascular disease. Pancreatitis A few cases of pancreatitis have been associated with<unk> . Erectile dysfunction Statins seem to have a positive effect on erectile dysfunction. Interactions Fibrates are a class of drugs that can be used for severe or refractory mixed hyperlipidaemia in combination with statins or as monotherapy. Concomitant therapy of<unk>  with drugs from the fibrate drug class (such as gemfibrozil, fenofibrate) can increase the risk of myopathy and rhabdomyolysis. Co-administration of<unk>  with one of CYP3A4 inhibitors such as itraconazole, telithromycin, and voriconazole, may increase serum concentrations of<unk> , which may lead to adverse reactions. This is less likely to happen with other CYP3A4 inhibitors such as diltiazem, erythromycin, fluconazole, ketoconazole, clarithromycin, cyclosporine, protease inhibitors, or verapamil, and only rarely with other CYP3A4 inhibitors, such as amiodarone and aprepitant. Often, bosentan, fosphenytoin, and phenytoin, which are CYP3A4 inducers, can decrease the plasma concentrations of<unk> . Only rarely, though, barbiturates, carbamazepine, efavirenz, nevirapine, oxcarbazepine, rifampin, and rifamycin, which are also CYP3A4 inducers, can decrease the plasma concentrations of<unk> . Oral contraceptives increased AUC values for norethisterone and ethinylestradiol; these increases should be considered when selecting an oral contraceptive for a woman taking<unk> . Antacids can rarely decrease the plasma concentrations of statin medications, but do not affect the LDL-C-lowering efficacy. Niacin also is proved to increase the risk of myopathy or rhabdomyolysis. Some statins may also alter the concentrations of other medications, such as warfarin or digoxin, leading to alterations in effect or a requirement for clinical monitoring. The increase in digoxin levels due to<unk>  is a 1.2 fold elevation in the area under the curve (AUC), resulting in a minor drug-drug interaction. The American Heart Association states that the combination of digoxin and<unk>  is reasonable. In contrast to some other statins,<unk>  does not interact with warfarin concentrations in a clinically meaningful way (similar to pitavastatin). Vitamin D supplementation lowers<unk>  and active metabolite concentrations, yet synergistically reduces LDL and total cholesterol concentrations. Grapefruit juice components are known inhibitors of intestinal CYP3A4. Drinking grapefruit juice with<unk>  may cause an increase in Cmax and area under the curve (AUC). This finding initially gave rise to concerns of toxicity, and in 2000, it was recommended that people taking<unk>  should not consume grapefruit juice "in an unsupervised manner." Small studies (using mostly young participants) examining the effects of grapefruit juice consumption on mainly lower doses of<unk>  have shown that grapefruit juice increases blood levels of<unk> , which could increase the risk of adverse effects. No studies assessing the impact of grapefruit juice consumption have included participants taking the highest dose of<unk>  (80 mg daily), which is often prescribed for people with a history of cardiovascular disease (such as heart attack or ischaemic stroke) or in people at high risk of cardiovascular disease. People taking<unk>  should consult with their doctor or pharmacist before consuming grapefruit juice, as the effects of grapefruit juice consumption on<unk>  will vary according to factors such as the amount and frequency of juice consumption in addition to differences in juice components, quality and method of juice preparation between different batches or brands. A few cases of myopathy have been reported when<unk>  is given with colchicine.
Atorvastatin
Clofibrate
Simvastatin
Fenofibrate
Lovastatin
Ezetimibe
Fluvastatin
Pravastatin