VIII. CHOLESTEROL-LOWERING DRUGS
A. HMC-CoA Reductase Inhibitors (Statins)
The statins, atorvastatin, fluvastatin, lovastatin, pravas-tatin, and simvastatin, are cholesterol-lowering agents that are effective and have few side effects. They cause a 20–40% reduction in total, or LDL, cholesterol. They may cause a small, 1–6%, increase in HDL cholesterol, but this effect is variable. Clinical trials have shown that these agents decrease LDL cholesterol levels and reduce the risk of heart attack and death from heart attacks. The newest agent, rosuvastatin, is even more powerful than Lipitor in reducing LDL levels to goal. Randomized clinical trials that document the effectiveness of these agents are given the chapter Dyslipidemia.
Mild side effects from statins include headaches, muscle aches, and pain in the upper abdomen without gastritis, ulcers, or bleeding. An increase in the liver enzymes may be detected on blood test, but the risk subsides when the drug is discontinued. Caution: Do not take with niacin or fibrates such as gemfibrozil or fenofibrate. Statins are contraindicated in pregnancy.
1. Atorvastatin
Supplied: Tablets: 10, 20, 40, 60 mg.
Dosage: 10–40 mg once daily; the author’s maximum dose is 60 mg daily. The 80 mg dose is rarely required and more adverse effects may occur at the maximal dose of the drug.