What is the number one side effect of rosuvastatin?

October 12, 2025 •

4 min read

According to cardiologist Craig D. Robison, MD, the most common side effects of rosuvastatin are muscle aches and pains, known medically as myalgia. These muscle-related issues are also the most frequent reason people stop taking this cholesterol-lowering medication.

Quick Summary

Muscle aches and pain, known as myalgia, are the most common side effect of rosuvastatin. While generally mild, this symptom can be bothersome and may be a precursor to more serious muscle conditions. Understanding and managing these and other potential adverse effects is crucial for maintaining cardiovascular health.

Key Points

Myalgia is the most common side effect: Muscle aches and pain, or myalgia, are the number one side effect reported by patients taking rosuvastatin, affecting about 10% of users.
Myalgia is distinct from myopathy and rhabdomyolysis: While myalgia is a common, often mild discomfort, myopathy (significant muscle damage) and rhabdomyolysis (severe muscle breakdown) are rare but more serious conditions.
Muscle symptoms can be managed: Strategies for dealing with muscle side effects include adjusting the dose, switching to a different statin, taking a temporary break from the medication, and incorporating lifestyle changes.
Lifestyle changes support medication effectiveness: A heart-healthy diet, moderate exercise, and limiting alcohol can help reduce cholesterol and may allow for a lower medication dose.
Supplements offer limited but potential benefits: Some patients may find relief from muscle pain with CoQ10 or Vitamin D supplements, though supporting research is inconsistent.
Immediate medical attention is crucial for severe symptoms: Dark urine, extreme weakness, or yellowing of the skin can indicate serious complications like rhabdomyolysis or liver problems and require immediate medical evaluation.

The Number One Side Effect: Muscle Aches and Pains (Myalgia)

For individuals taking rosuvastatin, a powerful statin used to lower cholesterol and reduce the risk of heart disease, the most frequently reported side effect is muscle pain, tenderness, or weakness. This condition, known as myalgia, affects approximately 10% of users and can manifest in various muscle groups, most commonly in the calves and thighs. For many, these symptoms are a significant enough concern that they choose to stop taking the medication.

The muscle discomfort can range from mild aches that are easily tolerated to more severe pain that affects daily activities. The exact mechanism behind statin-induced myalgia is not fully understood, but it is thought to involve the drug's effect on cellular processes within muscle tissue. Factors such as increased drug dose, advanced age, hypothyroidism, and underlying muscular disorders can increase the risk of developing these symptoms.

Understanding Statin-Associated Muscle Symptoms (SAMS)

The spectrum of muscle-related issues associated with statins is broader than simple myalgia. It is commonly referred to as Statin-Associated Muscle Symptoms (SAMS), and its manifestations vary widely among individuals. While mild myalgia is the most frequent occurrence, it is important to be aware of the more serious, albeit rare, conditions.

Differentiating Myalgia, Myopathy, and Rhabdomyolysis


Condition	Definition	Severity	Symptoms	Key Indicator	Risk	Management
Myalgia	Muscle pain, aches, or weakness without a significant rise in creatine kinase (CK) levels.	Mild to Moderate	Aches, stiffness, fatigue, cramps, typically in large muscle groups like the legs.	Normal to mildly elevated CK levels.	Relatively common; often temporary or manageable.	Dosage adjustment, switching statins, or lifestyle changes.
Myopathy	A general term for muscle damage characterized by muscle symptoms and a more significant increase in CK levels, typically more than 10 times the upper limit of normal.	Moderate to Severe	Muscle pain, tenderness, or weakness.	Significantly elevated CK levels.	Rare; requires medical attention.	Discontinue statin use under medical supervision.
Rhabdomyolysis	A rare but very serious condition involving the rapid breakdown of muscle tissue, releasing damaging proteins into the bloodstream.	Severe; Life-threatening	Severe muscle pain, weakness, and dark-colored urine.	Markedly increased CK levels and kidney damage.	Extremely rare; a medical emergency.	Immediate discontinuation of the drug and medical intervention to protect the kidneys.

Other Common and Less Common Side Effects

Beyond muscle issues, rosuvastatin can cause several other side effects, most of which are mild and temporary.

Common Side Effects (occur in 1-10% of users):

Headache: A frequently reported symptom, usually mild.
Nausea: Feeling sick to your stomach.
Constipation: Difficulty with bowel movements.
Weakness or fatigue: A general feeling of reduced energy.
Abdominal or stomach pain: Discomfort or cramps in the belly area.
Joint pain (Arthralgia): Aches and pain in the joints.

Less Common Side Effects (occur in less than 1% of users):

Dizziness
Difficulty falling or staying asleep (Insomnia)
Memory loss or confusion

Rare but Serious Side Effects of Rosuvastatin

While uncommon, certain serious side effects require immediate medical attention. It is critical for patients to be aware of the signs and symptoms.

Liver Problems: Rosuvastatin is processed in the liver, and in rare cases, it can cause liver injury. Symptoms include unusual fatigue, loss of appetite, upper belly pain, dark urine, or a yellowing of the skin or eyes (jaundice). Regular blood tests are often performed to monitor liver enzyme levels.
Increased Blood Sugar: Like other statins, rosuvastatin can increase blood sugar levels, potentially leading to or worsening type 2 diabetes, especially in individuals with existing risk factors.
Allergic Reactions: Though rare, a serious allergic reaction can occur. Symptoms include skin rash, itching, hives, or swelling of the face, lips, tongue, or throat.

Managing Rosuvastatin Side Effects

If you experience any adverse effects from rosuvastatin, you should speak with your healthcare provider. Never stop taking your medication without consulting a doctor first, as the risk of uncontrolled high cholesterol often outweighs the side effects. Here are several strategies your doctor might recommend:

Dosage Adjustment: A lower dose of rosuvastatin can sometimes alleviate muscle pain while still providing cholesterol-lowering benefits. Your doctor will evaluate if this is an appropriate option for you.
Statin Holiday: Your doctor may suggest stopping the medication temporarily for a few weeks. If the muscle symptoms resolve, it confirms the statin was the cause. You may then restart at a lower dose or try an alternative treatment.
Switching Statins: If muscle issues persist, your doctor may switch you to a different statin. Some statins have different chemical properties, and an individual may tolerate one better than another.
Combination Therapy: Adding a non-statin cholesterol-lowering medication, such as ezetimibe, can allow for a lower statin dose while maintaining effective cholesterol management.
Lifestyle Modifications: Maintaining a heart-healthy diet and engaging in regular, moderate exercise can help lower cholesterol and may reduce the need for higher doses of medication. Some evidence suggests regular exercise may decrease the likelihood of muscle pain.
Consider Supplements: Some people find relief from muscle pain with supplements such as coenzyme Q10 (CoQ10), but clinical trials have not consistently proven its effectiveness. If your vitamin D levels are low, supplementation may also help with muscle discomfort. Discuss any supplements with your doctor before starting them.
Check for Drug Interactions: Tell your doctor and pharmacist about all medications, supplements, and herbal products you take. Certain drugs, like some antibiotics and antifungals, can increase the risk of muscle side effects by interfering with rosuvastatin's metabolism.

Conclusion

While the number one side effect of rosuvastatin is myalgia, or muscle pain, it is a manageable condition for many patients. The vast majority of individuals who experience muscle aches do not have serious muscle damage. Close communication with your doctor is essential for identifying the cause of any muscle symptoms and finding a treatment plan that balances cholesterol management with a good quality of life. The cardiovascular benefits of rosuvastatin are well-established and often outweigh the risk of minor, temporary side effects. By understanding the spectrum of potential issues and working with your healthcare team, you can navigate treatment successfully.

Managing statin muscle pain

Frequently Asked Questions

For many, statin-related muscle pain, if it occurs, is temporary and resolves on its own after the first few weeks of taking the medication. If the pain persists or becomes bothersome, your doctor can help find a management strategy.

While any muscle can be affected, statin-related muscle pain and cramping are most commonly felt in the large muscle groups of the legs, such as the thighs and calves.

Myalgia is general muscle pain or weakness and is the most common muscle-related side effect. Rhabdomyolysis is a rare but severe condition involving rapid and extensive muscle breakdown, which can lead to kidney damage and requires immediate medical intervention.

Yes, but with care. Moderate, regular exercise can help and is part of a heart-healthy program. However, beginning a new, vigorous exercise regimen could increase the risk of muscle pain. Discuss your exercise plan with your doctor.

In rare cases, rosuvastatin can cause liver injury. Your doctor will likely conduct blood tests to monitor your liver function before and during treatment. Symptoms of a liver problem include unusual fatigue, dark urine, or yellowing of the skin and eyes.

Some people report reduced muscle pain with coenzyme Q10 (CoQ10) or vitamin D supplements, but clinical evidence is inconsistent. Always consult your doctor before starting any new supplement.

No, you should never stop taking your medication without consulting your doctor. They can determine if the pain is related to the statin and recommend an appropriate course of action, such as adjusting the dose or switching to a different medication.