Do Cholesterol Drugs Cause Diarrhea?

Statins and other cholesterol drugs can be powerful tools to prevent heart disease, but they do come with potential side effects. Can statin drugs cause diarrhea? Maybe, but it's rare. If you're worried your cholesterol medication may be causing diarrhea, read on and chat with your provider.

Your doctor can prescribe any number of drugs to lower your cholesterol, but statins are first-line treatment for the prevention of cardiovascular disease. This class of drugs can reduce your risk for heart attack, stroke and death due to heart disease by at least 25 percent, according to Johns Hopkins Medicine. And if you've already had a cardiovascular event, statins will likely be a component of your care plan moving forward.

Guy L. Mintz, MD, cardiologist and director of Cardiovascular Health & Lipidology at Northwell Health's Sandra Atlas Bass Heart Hospital in Manhasset, New York, confirms this, sharing that statins can lower cholesterol 30 to 50 percent. Statins work by preventing cholesterol from forming in the liver, according to the American Heart Association, reducing the amount of cholesterol circulating in the blood.

Of all the possible side effects of statins, diarrhea is rare.

According to the American College of Cardiology, diarrhea is a potential side effect of statins, along with constipation, indigestion, gas, heartburn, nausea and vomiting. Dr. Mintz says this is technically true, but that statins rarely cause gastrointestinal side effects.

There are other side effects commonly associated with statin medications though. About 7 to 20 percent of patients may have muscle symptoms, he says, which are most often muscle pain, soreness or weakness, according to the Mayo Clinic. A smaller percentage of patients may also experience liver problems, so your health care provider might keep an eye on your liver enzyme levels while on a statin.

Ezetimibe, the statin alternative that blocks absorption of cholesterol in the small intestine, causes diarrhea in 4 percent of patients, according to Dr. Mintz.

​Read more:​ How Pravastatin Can Affect Your Weight

So what should you do if you suspect the statin you're taking is causing diarrhea — or other side effects? Talk to your health care provider and discuss alternative options together.

Dr. Mintz points out that not all statins are the same chemically, so changing to another type of statin medication may be an option. It may also be possible to change the dosing to better manage side effects.

But for people who can't tolerate any statin, Dr. Mintz says the new non-statin medication bempedoic acid may be used. To completely avoid statins, there are several options and combinations of alternative medications, according to Dr. Mintz, including:

• Bempedoic acid alone.
• Bempedoic acid plus ezetimibe.
• PCSK9 therapy.
• PCSK9 therapy plus ezetimibe.
• PCSK9 therapy plus ezetimibe and bempedoic acid.

Statins aren't the only effective cholesterol drug, and sometimes they're more effective when paired with other medications. In these cases, Dr. Mintz says the second-line therapy is a non-statin cholesterol drug called ezetimibe, which can lower cholesterol 18 to 20 percent, but it's usually not enough to help patients achieve their cholesterol goal on its own.

The options continue: "Bempedoic acid can be added to ezetimibe to achieve a 35 percent reduction in cholesterol, or an 18 percent cholesterol reduction by itself," he adds. It can also be effective in combination with a statin for people who are not meeting their cholesterol goals through other drugs.

Finally, Dr. Mintz says that PCSK9 inhibitors can effectively reduce cholesterol 55 to 60 percent, but they're more expensive and involve injections given every 2 or 4 weeks. A July 2019 trial of more than 27,000 patients in ​JAMA Cardiology​ showed that the combination of PCSK9 inhibitors and statins packs a powerful punch against cardiovascular disease: Patients receiving a PCSK9 inhibitor and a statin had a significant reduction in cardiac events compared to study subjects taking only a statin.

But PCSK9 inhibitors can be used on their own as well. "This family of medications is also a viable option if patients are unable to tolerate statins," Dr. Mintz says.

​Read more:​ The 3 Major Causes of High Cholesterol Levels Are All Preventable