Common statins include the following — listed first by their generic name and, in parentheses, their brand name:
- Atorvastatin (Lipitor)
- Cholestipol (Cholestid)
- Colesevalam hydrochloride (Welchol)
- Fluvastatin (Lescol)
- Lovastatin (Mevacor)
- Ezetimibe (Zetia)
- Ezetimibe combined with simvastatin (Vytorin)
- Fenofibrate (Tricor)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Dyspnea (discomfort or difficulty breathing)
- Muscle pain
- Tendon complications
- Digestive problems
- Rush or flashing
- Increased blood sugar or type 2 diabetes
- Cognitive dysfunction (Some studies report that up to 75 percent of those on statins experienced cognitive dysfunction determined to be probably or definitely related to the statin therapy; the severity of the cognitive deficits were clearly related to statin potency.)
- Fatigue (Almost half of those in a 2012 study reported a significant increase in fatigue while taking statins.)
Very rarely, statins can lead to a kind of life-threatening muscle damage called rhabdomyolysis; it causes severe muscle pain and may result in liver damage, kidney failure and death. Rhabdomyolysis is especially likely to occur in those who take statins in combination with other drugs such as antibiotics and antidepressants or in those who take a high dose of statins.
Some people who take statins may develop nausea, gas, diarrhea or constipation. These side effects are rare.
A rash or flushing can also occur after taking a statin. This is more likely to occur in individuals who take a statin and niacin together, either in a combination pill such as Simcor or as two separate medications.
The FDA warns on statin labels that some people taking statins have developed memory loss or confusion; these effects are reversed when the medication is halted. Conversely, there has also been evidence that statins may help with brain function — in patients with dementia or Alzheimer's, for example. This effect is still being studied.
But no matter what side effects individuals taking statins may experience, it is important that they not stop taking the medication without talking to their doctor. It is also important that those who take statins minimize changes in their lifestyle, diet and over-the-counter medications, especially during dive-related travel.
Risk factors for statin side effects include the following:
- Taking multiple cholesterol-lowering medications
- Being 65 or older, female or having a smaller body frame
- Having kidney or liver disease or type 1 or 2 diabetes
- Drinking too much alcohol (more than two drinks a day for men age 65 and younger or more than one drink a day for women of all ages and men older than 65)
- Antimalarials, such as chloroquine and hydroxychloroquine (Plaquenil)
- Thyroid medications
Effect on DivingThough the side effects of some statins may interfere with diving, they may nevertheless offer overall health benefits.
One of the effects of statins is an increase in the body's production of nitric oxide. This helps to preserve the integrity of the endothelium (the inner lining of the blood vessels), to reduce injury from ischemia and/or reperfusion (a procedure that restores circulation after a heart attack or stroke) and to depress interdependent inflammatory and coagulation activity — all of which could provide protection against decompression sickness (DCS). On the other hand, a study of healthy divers who took either a statin or a placebo several days before a dive found no difference in their risk of postdive venous gas bubbles. Thus taking statins specifically to prevent DCS does not appear to offer any benefit, especially in view of the possibility of adverse side effects.
If you are over age 45 and are already taking statins for medical reasons, you need to answer "yes" to at least two questions on the Recreational Scuba Training Council (RSTC) Medical Statement (see the "Physical Activity Recommendations" section for details regarding this form):
Q: Are you presently taking prescription medications? (with the exception of birth control or anti-malarial)?
Q: Are you over 45 years of age and can answer YES to one or more of the following?
- Have a high cholesterol level
It is also of note that one-time clearance to dive does not preclude progression of a disease, so any changes in your health status should prompt another medical examination before you dive again. Divers should also be mindful of the fact that they may be required to fill out a new RSTC Medical Statement before any dive and that they may be denied permission to dive based on their responses. However, most dive operators will accept evidence of recent medical clearance for diving. If you are ever in any doubt about your fitness to dive, discuss your status with your dive operator in advance.