Typical Statin Regimen

Current treatment guidelines in the US, Canada, UK, and many other countries call for statins to be given to high-risk individuals even ones with no history of adverse cardiovascular events or strokes.

Patients who begin a stain drug regimen are generally prescribed the lowest dose possible to meet their needs, although increased dosages may be given to those who have suffered a heart attack. Different strength drugs are available for those needing to lower their LDL cholesterol levels by less than 30 percent as compared to those who need to lower their LDL levels by 30 percent or more.

Statins are generally taken as a single dose taken in the evening. The time of day the drugs are taken is important because the liver makes more cholesterol during the night. Occasionally, pills may be split (e.g., a 40 mg. pill into two 20 mg. pills) in order save money, but a doctor should always be consulted before doing this. Additionally, there is some evidence that grapefruit juice may increase the absorption of statins and the effectiveness of some statin drugs, allowing for a lower dose. Grapefruit may interfere with certain statins, however, so be sure to consult a doctor before employing either of these money-saving options.

Research into a once-every-two-days schedule shows that the dosage must be double to get the same effect as one-per-day pills. Because it's easier for patients to remember a once-per-day regimen, this is how most doctors recommend people take the medicine.

Patients who take statin drugs begin to see the first results after a couple weeks. Maximum effects are reached in four to eight weeks. Once you begin taking statins, you can typically expect to remain on them indefinitely unless there is a significant reduction in other risk factors, such as the loss of a large amount of weight or the cessation of smoking. If you are on a stain regimen and then stop, expect your cholesterol level to return to where it was at prior to the statin treatment.

In addition to the level of cholesterol in the blood, there are a number of other factors that doctors take into consideration before prescribing statin drugs. Family history, lifestyle, blood pressure, age, general health, presence of diabetes, weight and smoking habits all can have dramatic effects on cholesterol levels. Some people may have high blood cholesterol but no other risk factors, and therefore may not need to seek statin treatment.

There are six kinds of statin drugs. They differ somewhat in strength, cost, and side effects. Patients with a history of heart disease or a heart attack will likely be prescribed statin drugs in larger doses than other patients.

Dose-Response

Like most drugs, the higher the dosage of statins, the greater the benefits (and side effects). Medical community guidelines and doctor discretion establish the dosage for each patient. The trade-off between risks and benefits is what sets the dosage. A rule-of-thumb developed years ago is the "rule of 7" - for every doubling in doseage results in a 7% reduction in serum LDL levels.

Statins are taken indefinitely. Your doctor should monitor your general health and lipid profile over time and change your regimen as appropriate. The idea is that statins are maintenance medicine for the long term, not for a short-term fix. Concerns about long-term (e.g. decades) use have not resulted in systematic changes to treatment guidelines.

Availability, Compliance, and Other Lifestyle Changes

Your doctor may also suggest exercise or a special diet low in fats, sugars and/or cholesterol along with or in lieu of a statin drug regimen. It is important to follow these recommendations along with taking your prescription. Patients often forget to take their statins. People with cardiovascular problems who know they have the problems tend to be better at taking the medicine regularly than people who are taking them strictly for prevention.

Every decent-sized pharmacy carries the most popular statins because they are so widely used. For cost reasons or to get more rare concotions, some people use mail order pharmacies. There is a chance that in the future statins will be available over-the-counter. Some people feel this will increase usage and make patients more likely to stay on the pills. Given their importance to public health, experts look for any way to keep people on the drug.

Missing a Dose and Taking Too Many

The standard advice for daily prescription drugs is that if you miss a day, don't try to double up the next day. Just go forward with your normal schedule and take the same dosage as normal the next day. Your doctor will probably tell you the same thing for statins.

Manufacturers typically recommend taking statins at night, reasoning that the body makes cholesterol during periods of starvation (overnight). Studies mentioned in the British journal Bandolier show it makes little difference when the statin is taken.

It is hard to significantly harm yourself from consuming too many statins. All drugs can be dangerous when consumed in high dosages, but statins are quite safe. If for some reason you do swallow a large number of pills, call your local poison control service. In the United States, call 1-800-222-1222.

Framingham Risk Scoring

Importing statins from pharmacies in other countries

Brand names of statins


Interference with other medications

Like all prescription medications, statins can be taken only with a doctor's approval and the patient should be under a doctor's supervision. Be sure your doctor knows all medicines you take, including ones prescribed by other physicians and over-the-counter drugs.

The nature and dosage of your medications may effect what statin the doctor prescribes, at what level and dosage, or even if a statin is given at all.

These drugs are of concern:

Antifungals (including medicine for ringworm and athlete's foot)

Ciclosporin, often used to suppress immune response in organ transplant (this drug produces an adverse reaction with many other medicines)

Digitalis or Digoxin (brand name Lanoxin) - the widely used heart medication. Use with atorvastatin, fluvastatin, or simvastatin may increase blood levels of digoxin beyond the target level.

Fibrates - often given to people with high triglycerides, another lipid disorder. Also called fibric acid derivatives and sold as Lopid, TriCor, and Atromid.

Niacin - another chemical used to fight cholesterol disorder. However, there are indications that use with a statin can increase the changes of rhabdomyolysis and kidney problems. Can be prescription or over-the-counter.

Steroids, including synthetic testosterone and birth control pills.

Calcium-channel blockers used for blood pressure, which may increase the risk of rhabdomyolysis when used with statins

Some antibiotics (including erythromycin) and antiviral protease inhibitors (including saquinavir (Invirase), ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), and amprenavir (Agenerase)).

Medical Conditions your doctor must be aware of when prescribing statins

The doctor should also be aware of your entire medical history, as this may influence the choice of statin and dosage. Make sure your doctor know about tendencies for low blood pressure or seizures and recent or upcoming surgery (including dental surgery). Also of concern are:

Alcohol problems, past or present. (More on alcohol and statins)

Liver disease - a blood test to check for liver function is a routine part of statin medication care. Transaminase - a class of enzyme in the liver - is monitored in patients on statins. Elevated transaminase levels in the blood is a sign of possible liver damage.

Kidney problems

Electrolyte imbalances or metabolism problems

Organ transplants and any other infection

Taking a break

Doctors at Scrips Mercy Hopsital wrote about giving patients with problems a 6-week drug holiday to recover from side effects. During this time, they tell the patients to take 600 mg/day of coenzyme Q10 and to eat fish oil. They admit the evidence for benefits from coenzyme Q10 and fish oil is sketchy, but think risks are minimal.

Statins and drug holidays.

Healthy People and Statin Usage

Many medical authorities and public health experts feel statin usage should be even more widespread. And that people with no history of cardiovascular disease or of high cholesterol levels. Here's a French study on statin use in healthy people.



Statin Answers


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