Users

statin monitoring

Affected Drug

• C10AA01 Simvastatin
• C10AA03 Pravastatin
• C10AA02 Lovastatin
• C10AA04 Fluvastatin
• C10AA07 Rosuvastatin
• C10AA05 Atorvastatin

Baseline

Baseline: ALT/AST

Follow-up

Follow-up: consider q 6 months – ALT/AST, also consider at 3 months, 1 year and then no more unless symptomatic ** some guidelines suggest CK along with ALT/AST ** Many drug interactions are possible but none are likely to cause significant morbidity (usually just increased mylagia due to increased serum levels, consult pharmacist or reference material if concern about a specific interaction

Details

Conditions	System	Monitoring		ADE	Incidence	Recommendation
		Baseline	Follow-up
	hepatic	ALT/AST	ALT/AST at 3 mos, annually x1 then stop unless symptomatic; some experts suggest continual annual	hepatotoxicity	0.3-2% of ALT>3x ULN	Reduce dose or D/C
	MSK	N/A	prn Physical exam and CK	myalgia	5%	1)Dechallenge/rechallenge 2)↓ dose 3)Consider switching to fluvastatin or low dose rosuvastatin (5mg) or consider non-daily dosing (q2days for atorvastatin or rosuvastatin due to long t½)
				myositis	uncommon	↓ dose, monitor CK, consider #3 above
				rhabdomyolysis	<1/100,000	D/C, supportive care

References

• Genest J et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult – 2009 recommendations. Can J Cardiol 2009:25; 567-579
• Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med. 2009:150;858-68.
• Cooper A, et al . (2008) Clinical Guidelines and Evidence Review for Lipid Modification: cardiovascular risk assessment and the primary and secondary prevention of cardiovascular disease London: National Collaborating Centre for Primary Care and Royal College of General Practitioners