Statin Drugs
Currently there are six statins approved for use in the USA:
- Lovastatin was the first statin to be approved by the FDA in 1987 for the treatment of hyperlipidemia. The drug was isolated from a yeast strain of Aspergillus terreus. Clinical trials on the drug demonstrated its effectiveness in a 40% mean reduction of LDL cholesterol. Its maximum recommended dose is 80mg/day. Side effects are minimal and the drug is well tolerated by most individuals. The only serious side effect is myopathy and rhabdomyolsis, a rare complication that may occur with all statin drugs. Brand names of Lovastatin are Mevacor, Altoprev and Advicor (combined with niacin).
- Atorvastatin (Lipitor) is a synthetic statin. It is used as an adjunct to diet in primary hypercholesterolemia, familial hypercholesterolemia, or mixed hyperlipidemia in patients who have not responded adequately to diet or other non-pharmacological measures. The usual starting dose is 10 mg/day. This may be increased at intervals of at least 4 weeks to a maximum of 80 mg/day. Potential side-effects, in addition to those common to all statins include hypoesthesia, insomnia, dizziness, back pain, arthralgia, and asthenia; uncommonly, alopecia, anorexia, amnesia, malaise, muscle cramps, thrombocytopenia and tinnitus; rarely, pancreatitis, peripheral neuropathy and peripheral edema; and very rarely, erythema multiforme, hyperglycemia, hypoglycemia, peripheral neuropathy and Stevens-Johnson syndrome.
- Fluvastatin (Lescol) is a synthetic statin. It is used in patients with primary hypercholesterolemia or mixed dyslipidemia, primary hypercholesterolemia and concomitant coronary heart disease, coronary heart disease for the secondary prevention of coronary events after percutaneous coronary intervention. The recommended starting dose of Fluvastatin for lipid lowering is 40 mg daily in the evening. The dose may be increased to 80 mg/day. The recommended daily dose following percutaneous coronary intervention is 80 mg. Potential adverse effects include insomnia and very rarely, peripheral neuropathy, dysesthesia, hypoesthesia, thrombocytopenia, angioedema, vasculitis, edema, and lupus erythematosus-like reactions.
- Pravastatin (Pravachol) is a natural statin found in fungi. It is used as an adjunct to diet in patients with primary hypercholesterolemia or mixed dyslipidemia who have not responded adequately to dietary measures and other non-pharmacological treatments, moderate or severe hypercholesterolemia and at high risk of a first cardiovascular event, previous MI or unstable angina, with either normal or raised cholesterol levels and in patients receiving immunosuppressive therapy following an organ transplantation. Pravastatin is taken orally once daily in the evening, with or without food. The recommended dose range for hypercholesterolemia is 10-40 mg daily. A starting dose of 10 mg daily is recommended in patients with moderate or severe renal impairment or significant hepatic impairment. A starting dose of 20 mg daily is recommended for transplant patients receiving immunosuppressive therapy. Potential side-effects, in addition to those common to all statins include arthralgia and muscle cramps; rarely, dizziness, sleep disturbance, insomnia, vision disturbance, scalp/hair abnormality, abnormal urination, sexual dysfunction and fatigue; and, very rarely, peripheral perineuropathy and pancreatitis.
- Rosuvastatin (Crestor) is a synthetic statin used as an adjunct to diet in patients with primary when response to diet and other non-pharmacological treatments is inadequate and in patients with homozygous familial hypercholesterolemia. The recommended starting dose is 10 mg once daily, increased if necessary after not less than 4 weeks to 20 mg once daily. Further increasing the dose to 40 mg should only be considered in patients with severe hypercholesterolemia and high cardiovascular risk; specialist supervision is recommended. Potential adverse effects include proteinuria, dizziness, asthenia and rarely, arthralgia. In addition to the contraindications common to all statins, Rosuvastatin is contraindicated in patients with severe renal impairment and in patients taking Ciclosporin.
- Simvastatin (Zocor) is a semisynthetic statin based on Lovastatin. It is used in patients with primary hypercholesterolemia or mixed dyslipidaemia who have not responded adequately to diet and other nonpharmacological measures, patients with homozygous familial hypercholesterolemia, patients with manifest atherosclerotic cardiovascular disease or diabetes mellitus, as an adjunct to correction of other cardiovascular risk factors and other cardioprotective therapy. Simvastatin is licensed for use in 5-80 mg daily doses, given orally as a single dose in the evening. The 80-mg dose is only recommended in patients with severe hypercholesterolemia and at high risk of cardiovascular complications. The usual starting dose is 10-20 mg daily. Potential side-effects, in addition to those common to all statins are rare and they include alopecia, anemia, asthenia, dizziness, peripheral neuropathy and muscle cramps.
