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%