Typical Statin Regimen

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 contacted before this is attempted. 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 must be taken into consideration before taking 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 with varying strength and cost, and your doctor will prescribe the one that is right for you. Patients with a history of heart disease or a heart attack will likely be prescribed statin drugs in larger doses than other patients. (Recent work has confirmed what doctors suspects: treatment with statins following a heart attack can reduce mortality and reduce the risk of further attacks.)

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.

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. Lovastatin works better when it is taken with food. Grapefruit juice should also be avoided when taking statins.

Framingham Risk Scoring

Importing statins from pharmacies in other countries

Brand names of statins

Interference with other medications

Statins are prescription medications and can be taken only with a doctor’s approval and 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

Healthy People and Statin Usage

Many medical authorities and public health experts feel statin usage should be even 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.