Can Statins Cause Rhabdomyolysis? A Real Case of Rosuvastatin-Induced Rhabdo Explained

Statins are some of the most widely prescribed drugs in the world, but they can sometimes cause muscle problems. In rare cases, these problems progress to rhabdomyolysis, a dangerous form of muscle breakdown that can damage the kidneys if not recognized quickly. This article explains what rhabdo is, how often statins cause it, and a real case of delayed-onset rhabdomyolysis from rosuvastatin, a case that occurred in a woman after a full year of use without any problems.

Can statins cause rhabdomyolysis even after someone has taken them for years without problems?

Answer:

Yes. Although rare, delayed-onset statin-induced rhabdomyolysis can occur even after taking the drug for a long time. A recent case report describes a 63-year-old woman who developed severe rhabdomyolysis after a year on rosuvastatin, with creatine kinase rising above 31,000 U/L. Stopping the statin and giving IV fluids reversed the condition.

What Is Rhabdomyolysis and How Does It Affect the Muscles?

Rhabdomyolysis (rhabdo) is a serious condition where muscle cells break down faster than the body can repair them. When muscle tissue is damaged, it quickly releases large amounts of proteins and electrolytes into the bloodstream. The main protein released is myoglobin, and in high amounts, it can overwhelm the kidneys and lead to kidney injury. Exercise rhabdomyolysis is also possible in both athletes and non-athletes.

Many cases start with noticeable symptoms such as muscle pain, swelling, weakness, or dark urine. But the underlying problem begins at the muscle-cell level. As the muscle fibers break apart, they lose their ability to contract normally, which leads to weakness and difficulty walking or lifting the affected limb.

If rhabdomyolysis is not treated quickly, the buildup of myoglobin and other muscle breakdown products can strain the kidneys. This can cause sharp rises in kidney markers like creatinine and, in severe cases, lead to acute kidney failure.

Rhabdomyolysis can have many triggers, including unaccustomed intense exercise, infections, trauma, dehydration, and some medications. Statins are one of the most well-known drug-related causes, although severe muscle breakdown from statins is rare. Recognizing early symptoms and treating the condition right away with hydration can prevent long-term complications and help people recover fully.

The Case: A Sudden Decline After a Year of Statin Use

A 63-year-old woman had been taking rosuvastatin 40 mg daily for one year with no adverse effects. She had coronary artery disease, high cholesterol, and high blood pressure. Her daily medications included aspirin, prasugrel, clonazepam, clonidine, sertraline, trazodone, metoprolol, dicyclomine, and tramadol.

Symptoms

She developed progressive swelling, weakness, and pain in both lower legs. The weakness caused her to fall, but the muscle weakness symptoms started before the fall. She became unable to walk without assistance.

Hospital Findings

When she arrived at the hospital, doctors reported these signs and symptoms:

• Creatine kinase (CK): ~26,000 U/L (normal is 30 to 135)

  • CK peaked on day 3: 31,080 U/L

• Creatinine: 1.3 mg/dL (mild kidney involvement)

• ALT 168 and AST 407 (elevated liver enzymes)

• MRI: diffuse edema in the thigh muscles

• Muscle biopsy: clear muscle fiber degeneration consistent with rhabdomyolysis

What Happened?

In addition to getting IV fluids, her physicians halted her statin. Soon after, her CK levels began to decline, her swelling resolved, and her liver and kidney issues improved. She was discharged from the hospital after two weeks.

How Soon Does Statin-Related Rhabdomyolysis Usually Occur?

Rhabdo Book

Most statin-related rhabdomyolysis occurs early in therapy. One review found the average onset is about nine days after starting treatment. This woman had taken rosuvastatin for a full year without problems, which makes this delayed-onset case unusual and important for doctors and patients to understand.

Most clinicians expect symptoms to occur early, so cases like what happened to this 63-year-old woman can easily be mistaken for falls, injuries, or unrelated illness if doctors are not actively considering statins as a potential cause.

Which Statins Have Been Linked to Rhabdomyolysis?

Rhabdomyolysis from statins is rare, but all statins have reported cases.

These differences relate to dose, potency, and how each statin is metabolized, which affects how likely they are to accumulate and irritate muscle tissue.

In a meta-analysis, it was reported that, apart from cerivastatin, statins are not significantly associated with increased rhabdomyolysis risk in the general population, but interactions and various genetic factors do matter. Your physician can tell you more about your specific risks.

Can Rosuvastatin Cause Rhabdomyolysis?

Yes, rosuvastatin can cause rhabdomyolysis, although this complication is very rare. Rosuvastatin is generally considered one of the safer statins when it comes to muscle side effects, but no statin is completely risk-free. Severe muscle breakdown has been reported in people taking rosuvastatin, including cases that occurred early in treatment and others, like the case described in this article, that developed after a full year of stable use.

Factors can increase the chance of rhabdomyolysis with rosuvastatin include:

• taking a higher dose, such as 40 mg

• combining rosuvastatin with other medications that affect muscle metabolism

• dehydration, illness, or unaccustomed intense exercise

• kidney or thyroid problems

• genetic differences in how a person processes statins

How Statins Can Cause Rhabdomyolysis?

There are a couple of schools of thought on this. One proposed mechanism is that as statins reduce cholesterol production, they also reduce coenzyme Q10, which is essential for energy production inside muscle cells. This is why some advocate taking CoQ10 supplements alongside statins, although not all research proves this strategy is effective.

Another possible way statins contribute to muscle injury is through their direct impact on mitochondrial function. Mitochondria act like tiny batteries inside muscle cells. When statins reduce ATP energy production, the electrical balance of the muscle cells becomes disrupted, making them more vulnerable to damage. During unaccustomed or intense exercise, this energy deficit can increase the likelihood of rhabdomyolysis.

How Often Do Statins Cause Rhabdomyolysis?

Rhabdomyolysis from statins is very rare. Large clinical trials and reviews involving tens of thousands of patients show that severe muscle breakdown happens only in a tiny fraction of people who take these medications. One major analysis of more than 74,000 patients found no meaningful increase in rhabdomyolysis with currently available statins, except for cerivastatin, a drug removed from the market years ago.

Most cases that are reported tend to occur soon after starting treatment, often within the first few days or weeks. A review of 112 published cases found the average onset was about 9 days after beginning a statin. Delayed cases, like the one in this article that appeared after a full year of rosuvastatin use, are unusual and often involve other factors such as drug interactions, dehydration, kidney or thyroid issues, or higher statin doses.

Can Drug Interactions Increase the Risk of Rhabdomyolysis?

This woman was taking several drugs known to affect the metabolism and safety of statins. This opens the possibility that her bout of rhabdo may be due to an interaction with her other medications. For example, sertraline, a common antidepressant, has been linked to an increased risk of rhabdomyolysis on its own and may have contributed to rhabdo when combined with rosuvastatin. While the exact mechanism is not clear, both sertraline and rosuvastatin have been reported in case studies to increase susceptibility to muscle injury, and their combined use may have an additive effect.

How Common Are Muscle Symptoms in People Taking Statins?

Mild muscle symptoms such as aches, soreness, or fatigue do occur in some statin users, but the true rate is much lower than the often-quoted “25 percent.” In randomized clinical trials, muscle symptoms are usually reported in 1 to 5 percent of people taking statins, which is similar to placebo.

Higher numbers—like the 19–25 percent figure, come from voluntary reports sent in by patients and doctors, not from studies that measure how many people actually develop muscle symptoms.

The important point is that most muscle symptoms are mild and do not represent rhabdomyolysis. Severe muscle breakdown that leads to kidney strain is extremely rare.

Warning Signs of Muscle Damage You Should Not Ignore

Seek medical care right away if you notice:

• Muscle pain or tenderness that is new, severe, or progressive

• Weakness that makes walking difficult

• Visible swelling in the legs, arms or other areas, or inability to bend arms or legs

• Dark or cola colored urine

• Fever or feeling unwell

• Muscle cramps with no clear cause

• Declining exercise tolerance

Many people get mild muscle pain on statins. But pain combined with weakness or swelling should never be ignored.

Who Is Most at Risk for Statin-Related Rhabdomyolysis?

• people on high-dose statins

• those taking interacting medications

• people with kidney, liver, or thyroid problems

How Is Rhabdomyolysis Treated and How Fast Do People Recover?

One of the main goals of treating rhabdomyolysis is to protect the kidneys from damage. When muscle cells break down, they release myoglobin and other proteins into the bloodstream. If these build up too quickly, they can clog the kidneys and cause acute kidney injury. Treatment focuses on clearing these toxins as fast as possible.

Standard Treatment In The Hospital

The first line of treatment is usually aggressive intravenous hydration. Large amounts of IV fluids dilute the myoglobin released from damaged muscles and help the kidneys flush it out through the urine. Doctors also closely monitor electrolytes, since potassium and phosphorus can rise to dangerous levels when muscle cells rupture.

This use of IV fluids has given rise to the common misconception that simply drinking water prevents rhabdo, which is not true. In some cases, diuretics are used to maintain adequate urine output for those who may not be producing much urine.

If the kidneys become impaired, dialysis may be necessary, although most patients improve with fluids alone. In the case highlighted in this article, CK levels normalized within about 10 days, kidney function returned to normal, and the patient regained her strength after IV fluids and stopping rosuvastatin.

In rare, severe cases where swelling cannot be controlled, doctors may perform a fasciotomy, a surgical procedure that relieves pressure inside the muscle compartments to prevent permanent muscle or nerve damage.

How Long Does It Take To Recover From Rhabdo

Recovery time depends on how high the creatine kinase (CK) level is, how quickly treatment begins, and whether the kidneys or other organs are affected. Many people begin improving within 24 to 48 hours of receiving IV fluids. CK levels usually fall steadily once treatment starts.

Full recovery can take a few weeks to a few months, especially if muscle swelling or weakness was severe. Most patients regain normal strength once the damaged muscle fibers heal. For most people, long-term complications are unlikely, although there are some who complain of lingering fatigue and other issues long after they have been cleared by their physician.

FAQ: Statins & Rhabdo

Can statins cause rhabdomyolysis after years of use?

Yes. Most cases occur early, but as this case with the 63-year-old woman proves, delayed-onset rhabdo can happen even after long-term statin tolerance. It is rare, but it has been documented in people who had taken the same dose for months or years.

Which statin causes rhabdo most often?

Simvastatin at high doses and cerivastatin (withdrawn from the market) have the strongest links to rhabdo. Cases have also been reported with atorvastatin and rosuvastatin, especially when combined with interacting medications.

How do I know if I’m developing rhabdomyolysis?

Not everyone with rhabdo gets the classic symptoms. Some people do experience muscle pain, weakness, swelling, or dark urine, but others notice only unusual fatigue, trouble moving the affected limb, or feeling unwell. If muscle symptoms feel “out of proportion” or interfere with normal activity, you should get checked right away.

Should statins be stopped immediately if muscle pain occurs?

Not always. Mild muscle aches are common and often unrelated to rhabdo. But if the pain is severe, worsening, or accompanied by weakness, swelling, or difficulty walking, you should contact your healthcare provider immediately.

Who is most at risk for statin-related rhabdomyolysis?

People taking higher doses, those on interacting medications, patients with kidney or thyroid problems, people who become dehydrated, and anyone doing unaccustomed intense exercise may have a higher risk. Genetics also play a role.

Key Takeaways For People Taking Statins

Most people take statins for years without any serious muscle problems, but this case shows that severe muscle injury can still occur, even after long-term use. Rhabdomyolysis is rare, yet it becomes more likely when higher doses, drug interactions, or other risk factors are involved. The most important signs to watch for are increasing muscle pain, swelling, or weakness that doesn’t feel normal. Dark urine or trouble walking are especially concerning and need immediate medical attention. Staying aware of the warning signs and talking with your healthcare provider about any new symptoms is the safest way to stay on track with cholesterol treatment while protecting your muscle health.

If you want to understand rhabdomyolysis in greater depth, including symptoms, prevention strategies, and real stories from patients, check out my book Rhabdo: The Scary Side of Exercise You Need to Know About. It’s written in plain language and is one of the few resources that explains rhabdo in real-world terms.