Statins: How They Work, Side Effects (cont.)
Annette (Gbemudu) Ogbru, PharmD, MBA
Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
In this Article
- What are statins and how do they work?
- For what conditions are statins used?
- Are there differences among statins?
- What are side effects of statins?
- What are the drug interactions with statins?
- What are some examples of statins approved by the FDA in the U.S.?
For what conditions are statins used?
Statins are used for treating hyperlipidemia and heterozygous familial hypercholesterolemia for the primary and secondary prevention of coronary heart disease, (angina, heart attack), stroke, peripheral arterial disease (intermittent claudication). Statins have unapproved uses including rheumatoid arthritis and multiple sclerosis.
Are there differences among statins?
There are a variety of ways that statins differ. One of the differences involves potency in the ability to reduce cholesterol plasma levels. Rosuvastatin (Crestor) and atorvastain (Lipitor) are the most potent statins with respect to lowering LDL, followed by simvastatin (Zocor) and pravastatin (Pravachol).
Statins also differ in how strongly they interact with other drugs; this is due to drug metabolism. Of the statins, neither pravastatin (Pravachol) nor rosuvastatin (Crestor) undergo extensive CYP450 metabolism, and are likely to produce muscle toxicity such as myalgia, myopathies, and inflammation of the muscles due to increased plasma levels and subsequently interactions with other drugs.
In patients who have renal disease, dosages of pravastatin (Pravachol), lovastatin (Mevacor, Altocor), rosuvastatin (Crestor), and simvastatin (Zocor) should be adjusted to prevent increased plasma concentration. No adjustment is necessary for atorvastatin (Lipitor) or fluvastatin (Lescol).
The statins differ in their ability to cause side effects. Skeletal muscle toxicity such as rhabdomyolysis may occur when certain drugs are given with statins which causes an increase in the concentration of statins. Cerivastatin (Baycol) was withdrawn from pharmacies worldwide because it caused rhabdomyolysis 10 to 100 times more often than other statins.
Tips to keep it under control.