All about statin treatment


Dr KK Aggarwal    11 July 2018

  1. Give Rosuvastatin, atorvastatin when you want to lower LDL by more than 35%
  2. In CKD severe renal impairment give atorvastatin which does not require dose adjustment.
  3. In chronic liver disease suggest complete abstinence from alcohol and the use of pravastatin at a low dose (liver disease is unexplained aminotransferase values >3 times above upper normal range confirmed on repeat testing)
  4. Minimum pharmacokinetic drug interactions with atorvastatin ( not metabolized through the CYP3A4)
  5. Pravastatin and fluvastatin least muscle toxicity Do a baseline CK levels as a reference
  6. No routine monitoring of statins
  7. Report new onset myalgias or weakness
  8. Check baseline SGOT, SGPT levels prior to initiating statin therapy; routine monitoring of these levels is not necessary for patients on statins.
  9. Do TSH prior to initiating statin therapy.
  10. Atorvastatin and rosuvastatin are more effective at lowering triglycerides (14 to 33 percent) than other statins in patients with hypercholesterolemia
  11. Atorvastatin at doses of 5, 20, or 80 mg/day produces reductions in triglycerides of 27, 32, and 46 percent, respectively, and in LDL cholesterol of 17, 33, and 41 percent, respectively
  12. Statins are the first choice in virtually all patients with elevated LDL-C.
  13. In stable patients (outpatients) treat with high intensity statin (atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg daily) and prefer the highest approved dose in most cases.
  14. Start at the lower dosage of high intensity statin in patients 75 years of age or older
  15. In patients who do not tolerate one statin because of myopathy try another statin that may be better tolerated or to try alternative dosing regimens, often using low doses of rosuvastatin.
  16. For patients who cannot tolerate statin therapy consider a PCSK9 antibody.
  17. LDL-C should be monitored approximately six weeks after the initiation or change of treatment. If LDL reduction is substantially less than expected, possible non-tolerance or nonadherence to treatment should be carefully explored. Thereafter, measurement every 6 to 12 months is reasonable in patients adherent to lifestyle modifications to examine for continued adherence and increasing LDL levels with aging.
  18. With statins in particular, lipid levels stabilize within several weeks after a change in dose, and so checking lipid levels six weeks after a dosage change should provide a reliable result.
  19. The beneficial effects of statins occur sooner than can be explained by changes in LDL-C, and with discontinuation may reverse more quickly as well
  20. Statin therapy is contraindicated during pregnancy

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