COMPETITIVE OVERVIEW OF STATINS

a
Atorvastatin Simvastatin Pravastatin Lovastatin Fluvastatin
Brand name Lipitor® Zocor® Pravachol® Mevacor®, generic also available Lescol®, Lescol® XL

c
Manufacturer Pfizer Pharmaceuticals Merck & Co. Bristol-Myers Squibb Co. Merck & Co., generics Novartis Pharmaceuticals

e
manufactured by many companies
Inhibits the enzyme HMG-CoA reductase, the rate-limiting enzyme in the pathway of cholesterol synthesis

n
Function
Indications Prevention of cardiovascular Reduction of CHD mortality and Primary prevention of coronary Primary prevention of CHD Management of

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disease in adults with multiple risk cardiovascular endpoints in events in hypercholesterolemic hypercholesterolemia
factors patients at high risk of coronary patients (heterozygous familial and non-

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events familial) and mixed dyslipidemia

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Treatment of hypercholesterolemia Modification of lipid profile Secondary prevention of Coronary heart disease
disease– Slows Secondary prevention of coronary

n st
(in combination with diet) cardiovascular events progression of coronary events: reduces risk of coronary
atherosclerosis revascularization procedures

O A
Hyperlipidemia and mixed Hypercholesterolemia– In To slow progression of coronary
dyslipidemia conjunction with other preventive atherosclerosis

e
strategies, such as diet, to lower
risk for atherosclerotic vascular

s e
disease

U sid
Adolescent patients with
heterozygous familial
Contraindications Active liver disease or unexplained elevation of serum transaminase

d t
Hypersensitivity to any component of the medication

n ou
Women of childbearing age highly likely to conceive, or who are pregnant or nursing

u
Adverse events Generally, well tolerated, with adverse events being mild or moderate or similar to placebo
Warnings Liver dysfunction/persistent Myopathy/rhabdomyolysis, dose Liver enzyme abnormalities, Myopathy/rhabdomyolysis, dose Myopathy/rhabdomyolysis, dose

o d
elevations in serum transaminase related, risk increased if taken with including increase in serum related, risk increased if taken with related, risk increased if taken with

r
levels may occur CYP 3A4 inhibitors transaminase levels CYP 3A4 inhibitors other drugs. Rhabdomyolysis

g te
secondary to myoglobinuria

k u
Potential for rhabdomyolysis, along Increased serum transaminases Skeletal muscle disorders, Increased serum transaminases Liver dysfunction

c
with acute renal failure secondary to elevations of CPK levels,

a i b
myoglobinuria myalgia, myopathy, and

r
rhabdomyolysis

B t
Drug interactions Azole antifungals, colestipol, Substrate for CYP 3A4 Not metabolized by cytochrome Metabolized by CYP 3A4, but has Possible interactions with

s
cyclosporine, digoxin, erythromicin, P450 3A4 no CYP 3A4 inhibitory activity cholestyramine, cimetidine,

r i
fibric acid derivatives, niacin, and ranitidine, omeprazole, digoxin,

o
F ed
oral contraceptives phenytoin, diclofenac, glyburide,
and rifampicin
Risk of myopathy/elevated CPK CYP 3A4 inhibitors reduce Avoid combining with fibrates, CYP 3A4 inhibitors increase the Interaction with
levels, especially when clearance and increase the risk for potential increased risk of risk of myopathy immunosuppressive drugs not

b
coadministered with certain other myopathy myopathy observed in fluvastatin studies

t
agents
Interaction with other lipid-lowering Interactions with other lipid-lowering

o
drugs may also heighten risk of drugs may increase the risk of

n
myopathy myopathy
Possible interactions with

y
cyclosporine, danazol,
amiodarone, verapamil, digoxin,

a
and coumarin anticoagulants

M
 Atorvastatin Simvastatin Pravastatin Lovastatin Fluvastatin
Pediatric/ Yes Yes Yes Yes Not recommended (not studied in

a
Adolescent use patients <18)

c
(subject to
recommended

e
conditions)

n
Supplied 10, 20, 40, and 80 mg tablets 5, 10, 20, 40, and 80 mg tablets 10, 20, 40, and 80 mg tablets 10, 20, and 40 mg tablets 20 and 40 mg capsules
80 mg extended-release tablets

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Starting dose 10-20 mg/day for Typically initiated at 20–40 mg/day Typically initiated at 40 mg/day Typically initiated at 20 mg/day Starting dose for LDL-C reduction
hypercholesterolemia and mixed of •25%:
•25%: 40 mg capsule QD, 40

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dyslipidemia (40 mg for patients mg BID, or 80 mg extended-

l
requiring >45% reduction in LDL) release tablet once in evening

n st
10 mg/day for heterozygous and 10 mg/day in heterozygous familial 20 mg/day for ages 8–13 10–20 mg/day in heterozygous Starting dose for LDL-C reduction
homozygous familial hypercholesterolemia adolescents familial hypercholesterolemia of <25%: 20 mg/day

O A
hypercholesterolemia (12–17 yrs) adolescents (10–17 yrs)
40 mg /day for ages 14–18

e
Max dose/day 80 mg 80 mg 80 mg 80 mg 80 mg

s
Once daily, with or without meals Single daily dose, in the evening, Once a day, anytime, with or Single daily dose, in the evening, or Evening, doses can be once or

e
Administration
or up to 3 divided daily doses for without meals two divided daily doses, with meals twice daily but may not exceed 80

U sid
patients on 80 mg daily dose mg/day, with or without meals
Clinical studies ASCOT-LLA, CARDS, MIRACL, 4S, A to Z, HPS, IDEAL, and ALLHAT-LLT, CARE, LIPID, AFCAPS/TexCAPS ALERT and LIPS
TNT, IDEAL, PROVE-IT, MERCURY I PROSPER, WOSCOPS, PROVE-

d t
REVERSAL, and STELLAR IT, REVERSAL, and MERCURY I

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r o d
k g te
a c b u
B t r i
o r i s
F ed
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a y
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