You've successfully added to your alerts. This website also contains material copyrighted by 3rd parties. fIncludes 0-1 risk factors. Laboratory data were assessed immediately prior to rosuvastatin EOD therapy and at the first follow-up. [7,8,9,10] Additionally, moderate-to-high statin doses possess a rather flat dose response relative to low doses. Majority of Generic Drug Ingredients Produced in Asia -study, Critical Drugs for Critical Care: Protecting the US Pharmaceutical Supply in a Time of Crisis, SAMSON Answers the Statin Side Effect Question. bIncludes ≥2 risk factors, 10-y CHD risk 10-20%. You must declare any conflicts of interest related to your comments and responses. [though going up to the balcony at Stratford on the … [19] reported that 43% of patients with previous statin-associated myopathy tolerated a different statin without a recurrence of symptoms. iDosed daily. At 12 weeks, the LDL-C was reduced by 35% and 38% in the every-other-day and every-day groups, respectively (P =.49). [16] The doses of rosuvastatin used in our study were 2.5, 5, or 10 mg EOD (mean 5.6 mg). HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; TC = total cholesterol; TG = triglycerides. hIncludes plant stanol/sterols, policosanol, flaxseed oil. fIncludes 0-1 risk factors. The 80% rate of tolerance in that investigation is similar to what we observed (72.5%; 37/51) in the present study. [3] An observational study, the PRIMO (Prediction of Muscular Risk in Observational conditions), reported muscle complaints in 10.5% of the 7924 statin-treated subjects,[4] suggesting that statin-induced myopathy is considerably more frequent in clinical practice. HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; TC = total cholesterol; TG = triglycerides. Burnout Might Really Be Depression; How Do Doctors Cope? We elected to use rosuvastatin in an EOD regimen because its half-life of approximately 19 hours is the longest of available statins,[20] and it is the most potent statin at reducing LDL-C levels. This website also contains material copyrighted by 3rd parties. Statin-related myalgias and hepatotoxicity are dose-related and so reducing systemic drug concentration may lower the incidence of ADRs and potentially increase adherence to the regimen. [17] Lastly, we reported mean LDL-C reductions of 29% and tolerance in 80% of subjects (n = 10) previously intolerant to statin therapy when given rosuvastatin (mean dose 10 mg) once weekly.[18]. Please enter a Recipient Address and/or check the Send me a copy checkbox. Background: Statins are generally well tolerated, but some patients discontinue therapy secondary to adverse effects. You will receive email when new content is published. Dosage needs to be individualized but initially should start at 10-20 mg/day (Asian/pediatric patients: 5 mg/day) and be guided by the results of cholesterol tests taken 2 to 4 weeks later. Patients with coronary disease should be treated with statins to achieve an low-density lipoprotein cholesterol (LDL-C) <100 mg/dl and <70 mg/dl for very high-risk patients. Objective: To determine the effect and tolerance of EOD rosuvastatin in patients previously intolerant to statin therapy. eIndicates optional goal from ATP-III Update. aIncludes CHD or CHD risk equivalent, 10-y risk >20%. Do not take 2 doses of CRESTOR within 12 hours of each other. Statin-related myalgias and hepatotoxicity are dose-related and so reducing systemic drug concentration may lower the incidence of ADRs and potentially increase adherence to the regimen. James M Backes, PharmD,1,2 Carmelo V Venero, MD,3 Cheryl A Gibson, PhD,4 Janelle F Ruisinger, PharmD,5 Patricia A Howard, PharmD FCCP BCPS,5 Paul D Thompson, MD,6,7 Patrick M Moriarty, MD 8 1Department of Pharmacy Practice, Schools of Pharmacy and Medicine, University of Kansas, Kansas City, KS 2Lipid, Atherosclerosis, Metabolic and LDL-Apheresis Center, University of Kansas Medical Center, Kansas City, KS 3Hartford Hospital, Hartford, CT 4Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 5Department of Pharmacy Practice, Schools of Pharmacy and Medicine, University of Kansas, Kansas City, KS 6The Henry Low Heart Center, Hartford Hospital, Hartford, CT 7University of Connecticut, Farmington, CT 8Department of Internal Medicine; Lipid, Atherosclerosis, Metabolic and LDL-Apheresis Center, University of Kansas Medical Center, Kansas City, KS. A recent case report involving 2 patients previously intolerant to atorvastatin indicated tolerance to rosuvastatin when dosed on Monday, Wednesday, and Friday, and LDL-C reductions of 20% and 38% after 6 weeks with 2.5-mg and 5-mg doses, respectively. Overall, these agents have a remarkable safety profile, although some patients are intolerant of them. The myalgias and elevation in hepatic enzymes caused by statin therapy are considered to be dose-dependent adverse effects. Please see our, 2001http://www.medscape.com/features/year-in-medicine/public/2014. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. © 2008  Harvey Whitney Books Company. [5] Moreover, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III) Update emphasized LDL-C reductions of at least 30-40% and the option of more aggressive LDL-C goals for patients considered at high-risk for a cardiovascular event. Conclusions: Treating patients intolerant to statins with rosuvastatin EOD was tolerated by the majority of patients and reduced LDL-C in our study. cIncludes ≥2 risk factors, 10-y CHD risk <10%. eIncludes ≥2 risk factors, 10-y CHD risk <10%. Commenting is limited to medical professionals. Objective: To determine the effect and tolerance of EOD rosuvastatin in patients previously intolerant to statin therapy. 2008;42(3):341-346. I realize the pain could also have lessened just because I hadn't done a lot of stairs since then, too. [1] Nonspecific muscle complaints or joint pain without elevated creatine kinase levels have been reported in approximately 5% of clinical trial participants;[2] however, the range is wide (0.3-33%). iDosed daily. [16] Of the 15 patients who previously reported myalgias, 12 (80%) had a resolution of symptoms with EOD dosing. [21] Atorvastatin also has a long half-life (~14 h) and has demonstrated effectiveness with EOD dosing. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are well established as treatment for lowering low-density lipoprotein cholesterol (LDL-C) and reducing cardiovascular events. We cannot specify why the EOD regimen was better tolerated by these patients. cIncludes CHD or CHD risk equivalent, 10-y risk >20%. The Annals of Pharmacotherapy. Asian people may be particularly sensitive to Crestor and require lower dosages. Rosuvastatin appears to be a rational choice for markedly improving lipoprotein levels in statin-intolerant patients because of its high potency, long half-life, and lack of CYP3A4 metabolism. Dosing a statin (rosuvastatin) every other day (EOD) may provide significant lipoprotein changes while avoiding common adverse effects in this statin-intolerant population. cIncludes ≥2 risk factors, 10-y CHD risk <10%. [16] The study reported here examined the effect and tolerance of EOD rosuvastatin therapy in a considerably larger cohort. [16] Also, lovastatin, simvastatin, and atorvastatin are largely metabolized by CYP3A4, which is responsible for the conversion of many lipid-soluble agents to their hydrophilic forms for clearance and is a primary isoenzyme involved in many common drug interactions. Fifty-one patients were eligible for the analysis, which evaluated changes in the lipid profile, the number achieving their low-density lipoprotein cholesterol (LDL-C) goals, and the percent tolerating rosuvastatin EOD. [22], The Annals of Pharmacotherapy. Will Biased Ligands Be the Opioids of the Future? [6] These factors produce the common clinical challenge of achieving an aggressive LDL-C goal in a high-risk patient intolerant to statin therapy. Mean LDL-C decreased 34.5% (p < 0.001) in the patients who tolerated the regimen, enabling approximately 50% to achieve their LDL-C goal.