Available Forms
The statins are divided into two groups: fermentation-derived and synthetic. They include, along with brand names, which may vary between countries:
| Statin | Image | Brand name | Derivation | Metabolism |
|---|---|---|---|---|
| Atorvastatin | Lipitor, Torvast | Synthetic | CYP3A4 | |
| Cerivastatin | Lipobay, Baycol. (Withdrawn from the market in August, 2001 due to risk of serious Rhabdomyolysis) | Synthetic | various CYP3A isoforms | |
| Fluvastatin | Lescol, Lescol XL | Synthetic | CYP2C9 | |
| Lovastatin | Mevacor, Altocor, Altoprev | Fermentation-derived. Naturally occurring compound. Found in oyster mushrooms and red yeast rice. | CYP3A4 | |
| Mevastatin | Compactin | Naturally occurring compound. Found in red yeast rice. | CYP3A4 | |
| Pitavastatin | Livalo, Pitava | Synthetic | ||
| Pravastatin | Pravachol, Selektine, Lipostat | Fermentation-derived. (A fermentation product of bacterium Nocardia autotrophica). | Non CYP | |
| Rosuvastatin | Crestor | Synthetic | CYP2C9 and CYP2C19 | |
| Simvastatin | Zocor, Lipex | Fermentation-derived. (Simvastatin is a synthetic derivate of a fermentation product ofAspergillus terreus.) | CYP3A4 | |
| Simvastatin+Ezetimibe | Vytorin | Combination therapy | ||
| Lovastatin+Niacin extended-release | Advicor | Combination therapy | ||
| Atorvastatin+Amlodipine Besylate | Caduet | Combination therapy - Cholesterol+Blood Pressure | ||
| Simvastatin+Niacin extended-release | Simcor | Combination therapy |
LDL-lowering potency varies between agents. Cerivastatin is the most potent, (withdrawn from the market in August, 2001 due to risk of serious Rhabdomyolysis) followed by (in order of decreasing potency), rosuvastatin, atorvastatin, simvastatin, lovastatin, pravastatin, and fluvastatin. The relative potency of pitavastatin has not yet been fully established.
Some types of statins are naturally occurring, and can be found in such foods as oyster mushrooms and red yeast rice. Randomized controlled trials found them to be effective, but the quality of the trials was low. Most of the block-buster branded statins will be generic by 2012, including atorvastatin, the largest selling branded drug.
| Statin Equivalent Dosages | ||||||
|---|---|---|---|---|---|---|
| % LDL Reduction (approx.) | Atorvastatin | Fluvastatin | Lovastatin | Pravastatin | Rosuvastatin | Simvastatin |
| 10-20% | -- | 20 mg | 10 mg | 10 mg | -- | 5 mg |
| 20-30% | -- | 40 mg | 20 mg | 20 mg | -- | 10 mg |
| 30-40% | 10 mg | 80 mg | 40 mg | 40 mg | 5 mg | 20 mg |
| 40-45% | 20 mg | -- | 80 mg | 80 mg | 5–10 mg | 40 mg |
| 46-50% | 40 mg | -- | -- | -- | 10–20 mg | 80 mg* |
| 50-55% | 80 mg | -- | -- | -- | 20 mg | -- |
| 56-60% | -- | -- | -- | -- | 40 mg | -- |
| * 80mg dose no longer recommended due to increased risk of rhabdomyolysis | ||||||
| Starting dose | ||||||
| Starting dose | 10–20 mg | 20 mg | 10–20 mg | 40 mg | 10 mg; 5 mg if hypothyroid, >65 yo, Asian | 20 mg |
| If higher LDL reduction goal | 40 mg if >45% | 40 mg if >25% | 20 mg if >20% | -- | 20 mg if LDL >190 mg/dL (4.87 mmol/L) | 40 mg if >45% |
| Optimal timing | Anytime | Evening | With evening meals | Anytime | Anytime | Evening |
Read more about this topic: Statin
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