Statins

Question 1

List the statins.

Answer 1

Atorvastatin (Lipitor, Trovas)
Fluvastatin
Pravastatin (Pracachol, Cholstat)
Rosuvastatin (Crestor)
Simvastatin (Simvahexal, Zocor)

Question 2

What are the AEs of statins?

Answer 2

Common

• myalgia
• GI symptoms
• headache
• insomnia
• dizziness
• elevated aminotransferase concentrations (dose-dependent, generally responds to a reduction in dosage)

Rare
> myopathy
> rhabdomyolysis renal
- risk of myopathy (with or without creatine kinase elevation) and rhabdomyolysis is dose-related
- risk is increased by illness/certain DIs

Question 3

What are the indications of statins?

Answer 3

• hypercholesterolaemia
• mixed hyperlipidaemia
• high risk of coronary heart disease, with or without hypercholesterolaemia

Question 4

What are the counseling points of statins?

Answer 4

• take in the evening, because morning doses are slightly less effective. (Atorvastatin and rosuvastatin can be taken at any time, as they are not affected like this.)
  > this is due to half life of lipitor/crestor, can last 24hrs, the rest have short half life and effect won’t last for 24hrs
  > the liver break down the lipids during the night
• seek medical advice promptly if your urine is dark (brown) or if you have any muscle pain, tenderness or weakness
• avoid grapefruit juice as it may increase the amount of simvastatin in your bloodstream and could increase the chances of side effects occurring (Simvastatin, Atorvastatin)

Question 5

Monitoring.

Answer 5

• aminotransferase
• creatine kinase (CK)
  > at baseline & repeat during tx if indicated

Question 6

What are the dose ranges of statins?

Answer 6

Rosuvastatin:
5-40mg d

Atorvastatin/Simvastatin:
10-80mg d

Pravastatin/Fluvastatin:
20-80mg d

Question 7

What is the mode if action of Statins?

Answer 7

• competitively inhibit HMG-CoA reductase (a rate-limiting enzyme in cholesterol synthesis)
• increase hepatic cholesterol uptake from blood
• reduce concentrations of total cholesterol, LDL and triglyceride (modest), and produce a small increase in HDL concentrations