Statins (atorvastatin, simvastatin, etc.) are one of the most commonly prescribed classes of medications. Let me share a few common clinical pearls on statins. If you like some more pearls in audio format, be sure to check out the podcast!
- Statins should also be dosed at night right? Well…if you look at the package insert of each statin, you will find that some are recommended to be dosed at night and some aren’t (simvastatin says give at night for best effect, rosuvastatin and atorvastatin say it doesn’t matter). With simvastatin, if I have a patient who doesn’t like to take meds at night or has trouble remembering, I don’t feel strongly enough to push the issue. I would rather have them remember to take it than not, regardless of the time.
- LFT’s – Are routine liver function tests recommended with statins? Not anymore.
- Muscle pain – Myopathy is a common adverse effect, but I’ve definitely seen this missed in the elderly. Polypharmacy, painful disease states like osteoarthritis can potentially allow statins to be overlooked as a cause of myopathy. It is also important to consider adding drugs to a medication regimen that can increase concentrations of statins (amiodarone, amlodipine, diltiazem, azoles are a few common meds that can increase concentrations of certain statins).
- Rhabdomyolysis is extremely rare, but very serious. CPK is one of the most important labs to assess if rhabdomyolysis is a possible concern.
- High, moderate, and low dose statin therapy – This is a great table from the Annals of Internal Medicine about the ACC/AHA guidance. Reference Article
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