We elected to use rosuvastatin in an EOD regimen because its half-life of approximately 19 hours is the longest of available statins,[20] and it is the most potent statin at reducing LDL-C levels. an = 37. bAverage time to follow-up 4.1 ± 2.9 months. [16] Also, lovastatin, simvastatin, and atorvastatin are largely metabolized by CYP3A4, which is responsible for the conversion of many lipid-soluble agents to their hydrophilic forms for clearance and is a primary isoenzyme involved in many common drug interactions. Narrative review: statin-related myopathy. aIncludes CHD or CHD risk equivalent, 10-y risk >20%. eIndicates optional goal from ATP-III Update. 2002;22:21-26.5. Please confirm that you would like to log out of Medscape. )Statin-related myalgias and hepatotoxicity are dose-related and so reducing systemic drug concentration may lower the incidence of ADRs and potentially increase adherence to the regimen.3 Every-other-day dosing, especially of the newer statins with longer half-lives (ie, rosuvastatin and atorvastatin), has also been shown to preserve lipid-lowering benefits.3 Every-other-day dosing has been studied in all statins with the exception of pitavastatin. hIncludes plant stanol/sterols, policosanol, flaxseed oil. eIncludes ≥2 risk factors, 10-y CHD risk <10%. 2008;42:341-346.6. Pharmacotherapy. In fact, statins are frequently discontinued as a result of ADRs1,2 and for an inability to pay,2 leaving many statin-eligible patients at increased risk for cardiovascular morbidity and mortality.There are several alternative dosing strategies that may improve tolerability of these drugs for patients with muscle pain while preserving therapeutic benefits. Reindl E, Wright BM, Wargo KA. Possible explanations include the positive psychological effect of EOD treatment or lower plasma and muscle concentrations. Zhang H, Plutzky J, Skentzos, et al. A lipid profile was determined as baseline, at 4 weeks and again at 8 weeks. If you log out, you will be required to enter your username and password the next time you visit. Burnout Might Really Be Depression; How Do Doctors Cope? Statin-related myalgias and hepatotoxicity are dose-related and so reducing systemic drug concentration may lower the incidence of ADRs and potentially increase adherence to the regimen. Discontinuation of statins in routine care settings: a cohort study. These results suggest that many patients with a previous intolerance to statins can tolerate rosuvastatin EOD, attain significant LDL-C reductions, and achieve their LDL-C goal. In many cases, the study found, patients were able to tolerate the alternate-day regimen and were adherent at 1-year follow-up.1 For patients who cannot tolerate such a rechallenge, there are other options. Dosing a statin (rosuvastatin) every other day (EOD) may provide significant lipoprotein changes while avoiding common adverse effects in this statin-intolerant population. This website also contains material copyrighted by 3rd parties. One proposed mechanism of improving statin tolerance is alternate day statin therapy;12, 13, 14 but so far no specific management goals and treatment plans exist for South Asians because of lack of data. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 77th Congress of the European Atherosclerosis Society; April 26-29, 2008; Istanbul, Turkey. [16] The doses of rosuvastatin used in our study were 2.5, 5, or 10 mg EOD (mean 5.6 mg). cIncludes ≥2 risk factors, 10-y CHD risk <10%. Majority of Generic Drug Ingredients Produced in Asia -study, Critical Drugs for Critical Care: Protecting the US Pharmaceutical Supply in a Time of Crisis, SAMSON Answers the Statin Side Effect Question. May be taken at any time of the day (morning or night); however, it is best to … 2005;8:197-199. 2008;42(3):341-346. The average LDL-C reduction of 34.5% observed among the rosuvastatin EOD-tolerant group (mean dose 5.6 mg) in our study is consistent with the reduction shown in previous trials. You've successfully added to your alerts. James M Backes, PharmD; Carmelo V Venero, MD; Cheryl A Gibson, PhD; Janelle F Ruisinger, PharmD; Patricia A Howard, PharmD FCCP BCPS; Paul D Thompson, MD; Patrick M Moriarty, MD. You must declare any conflicts of interest related to your comments and responses. [1,5] Like other statins, atorvastatin is a competitive inhibitor of the 3-hydroxy-3-methylglutaryl-coenzyme-A (HMG-CoA) reductase, which is the rate-limiting step in cholesterol biosynthesis. Simply changing statins may also have contributed; Hansen et al. Tips. 2008;42(3):341-346. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. You will receive email when new content is published.