statins comparison chart

Upon symptom resolution, a low dose of an alternative statin should be initiated and titrated to the maximum tolerated dose.20,41 Patient acceptance and understanding of this process are important because the nocebo effect may otherwise lead to further perceived reactions. Atorvastatin and fluvastatin are considered the most cost-effective statins. FloLipid (simvastatin) package insert. 2005;352:1425-1435.16. When a statin is suspected as the cause of mild-to-moderate symptoms, temporary withdrawal is recommended. Each statin has different concerns regarding drug-drug and drug-food interactions because of the specific pathways through which each is metabolized (TABLE 5). Whitehouse Station, NJ: Merck & Co, Inc; February 2015.8. 38 Discontinuation of statin therapy and failure to resume statin therapy after the occurrence of adverse drug reactions are associated with increased rates of CVEs. Accessed June 20, 2018.32. Medicines use and spending in the U.S.: a review of 2015 and outlook to 2020. https://morningconsult.com/wp-content/uploads/2016/04/IMS-Institute-US-Drug-Spending-2015.pdf. Circulation. Statins are generally well tolerated; however, discontinuation rates remain high.38 Discontinuation of statin therapy and failure to resume statin therapy after the occurrence of adverse drug reactions are associated with increased rates of CVEs.39 Patients’ concerns about statin safety in light of two major statin-related AEs—myotoxicity and new-onset diabetes—may lead to statin discontinuation. BMJ. Several other strategies exist for managing and preventing these symptoms. Statin Effectiveness And Cost Comparison Recommend Generics *For all statins, check liver function tests at baseline and when clinically indicated. Eur Heart J. Statins for primary prevention of cardiovascular disease in elderly patients: systematic review and meta-analysis. Statins have been shown to increase the risk of diabetes development, although several important caveats exist.50 First, although this can be considered something of a class effect, the true risk of each specific statin is still unknown.51,52 In the largest meta-analysis to date, pravastatin had the lowest risk, simvastatin and atorvastatin had a moderate risk, and rosuvastatin had the highest risk of causing new-onset diabetes.53 None of these findings was statistically significant, however.53 Additionally, the finding that diabetes risk increases as the dose of statin increases has been inconsistent.54, Statin-induced diabetes is most prevalent in persons already at high risk for developing diabetes.50,54 This includes older patients and those with prediabetes or metabolic syndrome.50,55 One consistent finding has been that, for each new case of incident diabetes caused by statins, several CVEs can be prevented in higher-risk patients.50 Therefore, pharmacists should counsel anxious statin users at moderate or high risk for CV complications that the risk of developing diabetes is more than offset by the CV risk-reduction benefits. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Tomaszewski M, Stepien KM, Tomaszewska J, Czuczwar SJ. Riaz H, Khan AR, Khan MS, et al. Mayo Clin Proc. Zug, Switzerland: Covis Pharma; April 2017.9. 2004;350:1495-1504.20. Accessed March 18, 2018.46. 2017;376:1713-1722.30. FDA Drug Safety Communication: new restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury. Common causes include old age, drug interactions, impaired renal or hepatic function, increased physical activity, and vitamin D deficiency.20,41, Next, the clinician should compare the patient’s presentation with commonly seen statin-induced symptoms. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. Zhang H, Plutzky J, Shubina M, Turchin A. Diabetes Care. Statins are generally safe when used at recommended dosages. Statins also increase the number of LDL receptors on liver cells, which enhances 1. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Kastelein JJ, Akdim F, Stroes ES, et al. 2015;90:24-34.47. Reduce the risk of further heart disease in people with, pain or tenderness around the eyes and cheekbones. Baigent C, Landray MJ, Reith C, et al. ^Do not exceed 40mg Simvastatin unless patient has been on the 80mg dose for a year without myopathy. The 2013 ACC/AHA guideline introduced four treatment groups to be targeted for statin therapy: 1. Reproduction in whole or in part without permission is prohibited. 2017;389:2473-2481.43. Although statin therapy is not without risks, its benefits in reducing CV outcomes have made it the cornerstone of CVE prevention. Steven Kheloussi, PharmDAssistant Professor of Pharmacy PracticeWilkes University, Nesbitt School of PharmacyWilkes-Barre, Pennsylvania. Can J Cardiol. J Am Coll Cardiol. Lancet. With six statins available generically, the selection of an appropriate agent may be determined based on drug-specific factors, including dosing considerations, drug interactions, and adverse events. Some statins, particularly those metabolized by CYP 3A4 (such as atorvastatin, pravastatin and simvastatin), can interact with several other drugs, such as clarithromycin, protease inhibitors, cyclosporine, gemfibrozil, oral contraceptives, and digoxin. If similar symptoms are then experienced, the statin should be presumed the cause and discontinued. 2016;5. Several heavily debated treatment guidelines discuss the role of statins in treating hyperlipidemia. Individualized patient-care plans can be developed based on data from important clinical studies, differences in guidelines, and current management recommendations for two major adverse events associated with statin use. Lancet. Wiggins BS, Saseen JJ, Page RL, et al. People with active liver disease or who are pregnant or breastfeeding should not take statins. This article, which focuses on generic statins, will highlight the debate about statins’ role in therapy, discuss proper use, and explore evidence surrounding two major adverse events. Accessed March 18, 2018.22. All rights reserved. Circulation. Atheroscler Suppl. Fibrates: Although the combination of a fibrate and a statin has not been shown to meaningfully alter clinical outcomes, patients may still be prescribed gemfibrozil, fenofibrate, or fenofibric acid together with a statin to target severely uncontrolled hypertriglyceridemia.14,20,26,33 Because both of these classes are associated with muscle-related toxicity, combination therapy significantly increases this risk compared with either therapy alone.33 This additive toxicity is more frequently seen with gemfibrozil than with other fibrates.33 Therefore, gemfibrozil use is contraindicated with simvastatin and should be avoided with other statins.7,20 If a statin and a fibrate will be used together, fenofibrate or fenofibric acid is preferred.20,33 However, if gemfibrozil must be used, fluvastatin—or, with careful monitoring, atorvastatin or rosuvastatin (maximum 10 mg daily)—is the agent of choice.33, Amiodarone: This antiarrhythmic agent indicated for ventricular fibrillation is a known inhibitor of P-glycoprotein (Pgp) and the CYP450 enzyme system, specifically CYP3A4 and, to a lesser extent, CYP2C9.33,34 As a result, maximum recommended dosages exist for lovastatin (maximum 40 mg daily) and simvastatin (maximum 20 mg daily) when used with amiodarone.4,7,33 Although atorvastatin is metabolized through CYP3A4, no dosage adjustment is necessary (similarly to other statins) because data do not suggest serious AEs when atorvastatin and amiodarone are used concomitantly.2,33, CCBs: Both dihydropyridine (amlodipine) and nondihydropyridine CCBs (diltiazem, verapamil) have been shown to have meaningful drug interactions with statins.

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