DTB review: Which statin, what dose?
The authors of this DTB (Drug Therapy Bulletin) review discuss the relative merits of different statins in addressing cardiovascular risk under the following headings:
- Overview of effectiveness of statins
- Different statins at standard doses
- High versus standard doses of statins
- Unwanted effects
- Contraindications and precautions
- What do national guidelines say?
- Who needs high-dose therapy?
- Should patients be switched?
- Pravastatin: For patients in whom drug interactions are a problem, the interactions may be less likely if pravastatin is used instead. However, the weaker lipid-lowering effects of pravastatin make it a less attractive first choice.
- Atorvastatin: should be reserved for second-line treatment or for patients intolerant to simvastatin. Many patients currently taking atorvastatin could be switched to simvastatin, to gain similar benefits at lower cost.
- Rosuvastatin/fluvastatin: There are very limited clinical trial data for fluvastatin or rosuvastatin; these are much more expensive than simvastatin, and we can see no reason for using them in routine management.
Drug Therap Bull May 2007 Vol. 45 (5)