Table of Contents
Medications
Statins
Statins are considered the most effective drugs for the treatment of high cholesterol in most patients, particularly for lowering LDL levels. They also have modest effects in lowering triglycerides and increasing HDL levels. Statins inhibit the liver enzyme HMG-CoA reductase, which the body uses to manufacturer of cholesterol. These drugs effectively reduce the risk of major coronary events, including first and second heart attacks and stroke, in adults with unhealthy cholesterol levels.
Brands. Statins approved in the U.S. include:
- Lovastatin (Mevacor, generic)
- Pravastatin (Pravachol, generic)
- Simvastatin (Zocor, generic)
- Fluvastatin (Lescol)
- Atorvastatin (Lipitor)
- Pitavastatin (Livalo)
- Rosuvastatin (Crestor)
Statins may also be prescribed as fixed-dose combination drugs, which combine two drugs in one pill:
- Ezetimibe/simvastatin (Vytorin) combines two cholesterol medications that work in different ways.
- Amlodipine/atorvastatin (Caduet) is a dual-therapy medication that combines the antihypertensive calcium channel blocker amlodipine with atorvastatin. It is used to treat simultaneously high blood pressure and high cholesterol.
Statins may be prescribed along with other cholesterol-lowering drugs, such as bile acid-binding resins, nicotinic acid (niacin), and fibrates.
Side Effects. Statins tend to be better tolerated than other cholesterol-lowering drugs. Side effects may include gastrointestinal discomfort, headaches, skin rashes, muscle aches, sexual dysfunction, drowsiness, dizziness, nausea, constipation, and peripheral neuropathy (numbness or tingling in the hands and feet).
The primary safety concern with statins is an uncommon condition called myopathy, in which a patient may experience muscle pains and certain lab tests may be elevated. A specific myopathy, called rhabdomyolysis, can lead to kidney failure, but fortunately its occurrence is very rare. The risk for myopathy/rhabdomyolysis is highest at higher doses and in older people (over 65 years), those with hyperthyroidism, and those with renal insufficiency (kidney disease). Both statins and fibrates carry a risk for myopathy. The combination of the two drugs increases this side effect. Some people who use a statin-fibrate combination withdraw from the regimen because of muscle discomfort.
Review Date: 04/06/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
