Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Statins Update

Earlier this year the Summaries of Product Characteristics (SPC) for Atorvastatin (Lipitor®) and Ezetimibe/Simvastatin (Inegy®) were updated. These new documents list details of the expected reductions in total cholesterol from untreated baseline results.

A previous article has suggested a stepped approach to lipid management however the information in the updated SPCs has changed this advice.

Simvastatin 40mg is still the first line choice. Based upon an expected additional cholesterol reduction, atorvastatin 40mg is second line. Third line is atorvastatin 80mg.

Reversion to simvastatin 40mg with the addition of ezetimibe is no longer recommended as a third line option as the additional reduction in cholesterol is very small. The expected reduction in total cholesterol is 39% compared to a 38% expected reduction with the second line choice.

Action: The revised stepwise approach to lipid management is as suggested below:

  • Simvastatin 40mg tablets - expected total cholesterol reduction of 30%
  • Atorvastatin 40mg tablets - expected total cholesterol reduction of 38%
  • Atorvastatin 80mg tablets - expected total cholesterol reduction of 46%

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6 Comments to “Statins Update”

  1. […] Clinicians should be aware of this negative study. Current recommendations still apply, simvastatin 40mg remains first line and monotherapy with atorvastatin remains a […]

    Pingback by Ezetimibe doesn’t ENHANCE statins | Prescribing Advice for GPs — January 21, 2008 #
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  2. [...] Action: This study provides no justification for using rosuvastatin ahead of other statins with lower acquisition costs in patients over 60 years of age with heart failure. Cholesterol management should continue in line with current recommendations. Bookmark to: What are these? Copyright ©2007 Prescribing Advice for GPs [...]

    Pingback by Prescribing Advice for GPs » Rosuvastatin disappoints in HF — November 6, 2007 #
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  3. […] Action: This study provides no justification for using rosuvastatin ahead of other statins with lower acquisition costs in patients over 60 years of age with heart failure. Cholesterol management should continue in line with current recommendations. […]

    Pingback by Rosuvastatin disappoints in HF | Prescribing Advice for GPs — November 6, 2007 #
    Reply

  4. Susan,

    It's not really a question about how high your cholesterol is alone, but more of a question of how high your personal risk of having a cardiovascular event (like aheart attack or stroke) in the next ten years is based upon your risk factors, one of which is your cholesterol.

    The risk prediction should also take into consideration your age, gender, smoking status and blood pressure as a minimum with additional corrections for other factors like diabetes, obesity and family history.

    Comment by Matthew Robinson — August 22, 2007 #
    Reply

  5. How high does your cholestral have to be to take simvastatin 40mg?

    Comment by susan palmer — August 22, 2007 #
    Reply

  6. […] Patients who have already had a stroke should be prescribed a statin as per formulary recommendations to prevent further atherothrombotic […]

    Pingback by Atorvastatin in Stroke | Prescribing Advice for GPs — August 14, 2006 #
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