Some of the most surprising drug side effects don’t make the top of the list on that insert your pharmacist hands you with your prescription. Yet they can be both more dangerous and less obvious than, say, nausea, constipation or dizziness. We’re talking about soft-tissue injuries. Involving tendons, ligaments or muscles, these can be not only painful but also hard to heal. Here are some of the drugs mostly likely to cause this damage…

STATINS

These cholesterol-lowering drugs, including atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor or Altopre), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor) and pitavastatin (Livalo), also block the formation of coenzyme Q10 (CoQ10), essential for synthesizing ATP, a chemical produced by mitochondria, the tiny powerhouses in every cell. ATP is the fuel needed for every body function, from thinking to moving to healing wounds.

By interfering with CoQ10 and ATP production, statin drugs may not only cause muscle pain, which is now well-known, but also can cause ruptures of the biceps and Achilles tendons, tendinitis in the wrist and trigger finger. With trigger finger, one or more fingers can lock or catch as you bend and straighten your hand. Some people must unlock their fingers manually with the other hand! Also, if you have an existing repetitive strain injury, such as carpal tunnel syndrome, statins can worsen it by causing tendinitis.

What’s Better

If you must take cholesterol drugs, ask your physician about alternatives to statins. If you must take a statin, ask whether the dosage could be reduced and also take a daily 200 mg to 300 mg supplement of CoQ10 to offset the drug’s negative impact on mitochondria. The liquid form (Qunol) is best. Redoubling your lifestyle efforts to improve your diet and adding moderate exercise should also help reduce cholesterol in many people.

FLUOROQUINOLONES

These are drugs prescribed for acute illnesses such as bronchitis and sinus and urinary tract infections. The chief offender is ciprofloxacin (Cipro), but others include gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin. These drugs can cause tendon problems because they interfere with collagen-regulating components (called matrix metalloproteinases) that maintain tendon integrity (Reminder: Collagen cells are constantly replacing themselves.)

If you disturb this normal renewal process, the tendon may not have the strength to withstand the stress of repetitive motion and static posture. Some patients on Cipro for only one day have been brought to a standstill from the medication-induced aches and pains. Others experience tendinitis or nerve damage in the carpal tunnel system of the wrist or higher up in the neck and shoulder area.

What’s Better

Ask your doctor to prescribe another class of antibiotic based on the specific bug you are fighting.

AROMATASE INHIBITORS

Drugs in this group are used for treating hormone-positive breast cancer and include anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara). When you “inhibit” aromatase, which turns androgen into estrogen, your body stops making estrogen, which can fuel the growth of cancer cells. But there’s an association between using an aromatase inhibitor and developing trigger finger. Other side effects are joint stiffness and pain as well as bone loss and fractures.

What’s Better

Talk to your oncologist about taking tamoxifen instead of an aromatase inhibitor to help prevent a cancer recurrence.

CORTICOSTEROIDS

While prednisone and other drugs in this group can be absolutely lifesaving for people who otherwise couldn’t breathe because of asthma or COPD, they can make your soft tissues very thin and weak and potentially rupture tendons.

What’s Better

If you must take steroids, be on as low a dose as possible for as short a time as possible.

Lifestyle Habits That Help

When you must be on any of the above drugs, double down on other health measures to help resist these side effects. These include getting restorative sleep, eating a healthful diet and making sure to get the appropriate daily amounts of vitamins A, B-6, B-12, C and D. Don’t drink alcohol, don’t smoke and don’t eat gluten—gluten has been heavily hybridized and whether or not celiac disease (the intestinal wheat intolerance) is present, many patients experience gluten-related inflammation in a number of body systems.

While it’s important to be as physically fit as possible, when exercising, avoid strenuous moves that could tax your tendons, specifically yoga’s downward dog, the wrist-loading exercises such as the plank and strength-training with heavy weights—if you can’t lift a weight for eight reps without straining, the weight is too heavy.