Don’t Give Up on Statins
- Details
- Published: Thursday, 04 February 2016 13:25
- Written by 340B Editor
It is well established that statins are considered the first-line pharmacologic therapy for dyslipidemia. Statins have been proven to reduce atherosclerotic cardiovascular disease risk; however, nearly a third of patients started on statins report muscle aches or weakness. This all too often leads to giving up on the statin, which could potentially be a life-saving medication.
Cost may be a big factor for some patients. With the 2013 ACC cholesterol therapy guidelines, you may be surprised which statin provides “bang for the buck” considering 340B prices. It just may change what you prescribe.
Instead of discontinuing statins therapy, here are some alternatives you can try and a summary of statin 340B prices:
Rechallenge. Patients should try an alternative statin. Studies show about 90% of patients who stopped statin therapy due to side effects were able to tolerate after trying again. In fact, 40% of patients tolerated rechallenging with the same statin. Additionally, fluvastatin and pravastatin may have a lower risk of causing myopathy than the other statins.
Check for interactions. Atorvastatin, lovastatin, and simvastatin all can have increased risk of causing statin-induced myopathy with concurrent use with other medications that are CYP3A4 inhibitors. If CYP3A4 inhibitors cannot be avoided, try a statin less dependent on CYP3A4 metabolism, such as fluvastatin, pitavastatin, pravastatin, or rosuvastatin.
Try switching to fenofibrate. Patients on gemfibrozil can try fenofibrate, which has a lower risk of statin-induced myopathy than gemfibrozil.
Try alternative dosing strategies, such as every-other-day statin dosing.
Don’t give up on statins until you have tried some of these tips. It could be life saving.
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|
LDL Reduction |
340B Price |
Atorvastatin |
35% to 60% |
$15 to $25 |
Lipitor Brand |
35% to 60% |
$15 to $20 |
Fluvastatin |
25% |
$93 |
Lescol XL |
35% |
$15 |
Lovastatin |
21% to 31% |
$15 |
Pitavastatin (Livalo) |
32% to 45% |
$85 |
Pravastatin |
22% to 37% |
$16 to $25 |
Pravachol |
22% to 37% |
$16 to $25 |
Rosuvastatin (Crestor Brand) |
45% to 60% |
$36 |
Simvastatin |
25% to 45% |
$17 to $25 |
Zocor |
25% to 45% |
$55 to $90 |
Bold = Brand |
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Bold = Brand
Written by Seth M. Adams, Pharm.D.
References
1. PL Detail-Doc Characteristics of the Various Statins. Pharmacist’s Letter/Prescriber’s Letter. May 2012.
2. PL Detail-Doc. Lipid Treatment FAQs. Pharmacist’s Letter/Prescriber’s Letter. July 2014.
3. PL Detail-Doc, Statin-Associated Muscle Symptoms. Pharmacist’s Letter. June 2012.
4. PL Detail-Document, Statin Muscle Symptoms: Managing Statin Intolerance. Pharmacist’s Letter/Prescriber’s Letter. October 2015.
5. Rodriguez-Gutierrez R, Shah ND, Montori VM. Predicting the Overuse of PCSK-9 Inhibitors. JAMA. 2015;314(18): 1909-1910.