Articles

Don’t Give Up on Statins

It is well established that statins are considered the first-line pharmacologic therapy for dyslipidemia. Statins have been proven to reduce atherosclerotic cardiovascular disease risk; however, nearly a third of patients started on statins report muscle aches or weakness. This all too often leads to giving up on the statin, which could potentially be a life-saving medication.

Cost may be a big factor for some patients. With the 2013 ACC cholesterol therapy guidelines, you may be surprised which statin provides “bang for the buck” considering 340B prices. It just may change what you prescribe.

Instead of discontinuing statins therapy, here are some alternatives you can try and a summary of statin 340B prices:

 

 

Rechallenge. Patients should try an alternative statin. Studies show about 90% of patients who stopped statin therapy due to side effects were able to tolerate after trying again. In fact, 40% of patients tolerated rechallenging with the same statin. Additionally, fluvastatin and pravastatin may have a lower risk of causing myopathy than the other statins.

Check for interactions. Atorvastatin, lovastatin, and simvastatin all can have increased risk of causing statin-induced myopathy with concurrent use with other medications that are CYP3A4 inhibitors. If CYP3A4 inhibitors cannot be avoided, try a statin less dependent on CYP3A4 metabolism, such as fluvastatin, pitavastatin, pravastatin, or rosuvastatin.

Try switching to fenofibrate. Patients on gemfibrozil can try fenofibrate, which has a lower risk of statin-induced myopathy than gemfibrozil.

Try alternative dosing strategies, such as every-other-day statin dosing.

Don’t give up on statins until you have tried some of these tips. It could be life saving.

 

 

 LDL Reduction

 340B Price

Atorvastatin

 35% to 60%

$15 to $25

Lipitor Brand

 35% to 60%

$15 to $20

Fluvastatin

 25%

$93

Lescol XL

 35%

$15

Lovastatin

 21% to 31%

$15

Pitavastatin (Livalo)

 32% to 45%

$85

Pravastatin

 22% to 37%

$16 to $25

Pravachol

 22% to 37%

$16 to $25

Rosuvastatin (Crestor Brand)

45% to 60%

$36

Simvastatin

25% to 45%

$17 to $25

Zocor 

25% to 45%

$55 to $90

Bold = Brand

 

 

 

  • Bold = Brand

 

Written by Seth M. Adams, Pharm.D.

References
1.      PL Detail-Doc  Characteristics of the Various Statins. Pharmacist’s Letter/Prescriber’s Letter. May 2012.
2.      PL Detail-Doc. Lipid Treatment FAQs.  Pharmacist’s Letter/Prescriber’s Letter. July 2014.
3.      PL Detail-Doc, Statin-Associated Muscle Symptoms. Pharmacist’s Letter. June 2012.
4.      PL Detail-Document, Statin Muscle Symptoms: Managing Statin Intolerance. Pharmacist’s Letter/Prescriber’s Letter. October 2015.
5.      Rodriguez-Gutierrez R, Shah ND, Montori VM. Predicting the Overuse of PCSK-9 Inhibitors. JAMA. 2015;314(18): 1909-1910.

 

 

 

 

 

 


 


 

 

 

 

 

 

 

 

 

The 340B Drug Pricing Program is managed by the Health Resources and Services Administration (HRSA) Office of Pharmacy Affairs (OPA). For more information visit: www.hrsa.gov/opa This material is provided for general informational purposes of 340B Drug Prices only and is not an endorsement of any prescription product referenced herein. For information as to the clinical use or efficacy of a referenced product, please contact the manufacturer. 340B Price Guide makes no representations and provides no warranties as to the effectiveness or suitability for use of any prescription product referenced herein. Any referenced cost is provided as an estimate only and the actual cost is subject to change at any time and without notice. 340B Price Guide does not guarantee that the cost represented herein will be the actual and pharmacy shall at all times collect amounts due as indicated at the time of adjudication and shall be reimbursed per the terms of its agreement.'