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Statins

Introduction

Statins, also known as HMG-CoA reductase inhibitors, are prescription medications that help improve cholesterol levels. Statins block an enzyme in your body that creates cholesterol. This action reduces your total cholesterol level, including your low-density lipoprotein (LDL) or “bad” cholesterol level. It also increases your level of high-density lipoprotein (HDL), which is considered “good” cholesterol. These effects can reduce your risk of heart attack or stroke.

The very first statin, called lovastatin, was approved in the United States in 1987. Since then, six other statins have been developed and approved. These drugs all come in either a tablet or capsule that you take by mouth. In addition to the 7 statin-only drugs, there are 3 drugs that include a statin in combination with another drug.

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Statin list

List of statin medications

The following tables list statins that are currently available in the United States. The majority of these drugs are available in generic versions. Generic drugs are typically less expensive than brand-name drugs. They’re also more likely to be covered by health insurance plans.

All seven statins come in regular-release forms. This means that the drug is released into your bloodstream all at once. Two of the statins also come in extended-release forms, which are released into your bloodstream more slowly.

Statin Brand name Available as generic Regular-release Extended-release Form
atorvastatin Lipitor yes yes no tablet
fluvastatin Lescol, Lescol XL yes yes yes capsule, tablet
lovastatin Mevacor*, Altoprev yes yes yes tablet
pitavastatin Livalo yes yes no tablet
pravastatin Pravachol yes yes no tablet
rosuvastatin Crestor yes yes no tablet
simvastatin Zocor yes yes no tablet†
 

*This brand has been discontinued.

This drug is also available as an oral suspension, which is made up of solid particles of the drug in a liquid that you swallow.

Statin combination drugs

Three products combine statins with other drugs. Two of them pair a statin with ezetimibe, which also works to help lower your total cholesterol level. The third product combines a statin with amlodipine, which helps lower your blood pressure level.

Combination drug Brand Available as generic Form
atorvastatin/amlodipine Caduet yes tablet
atorvastatin/ezetimibe Liptruzet* yes tablet
simvastatin/ezetimibe Vytorin yes tablet
 

*This brand has been discontinued. This drug is now only available in a generic version.

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Selecting a statin

Considerations for selecting a statin

Not all statins are created equal. Certain statins are more potent, meaning they reduce your LDL and total cholesterol levels more than other statins. Some statins have been shown to reduce the risk of heart attack and stroke in people who have never had these events. This use is called primary prevention. With secondary prevention, the drugs are used to prevent the recurrence or heart attack or stroke.

Doctors usually only recommend statin combination products when you need dual therapy. For example, if your cholesterol levels do not respond as they should to treatment with just a statin, your doctor may have you take a drug that combines a statin with ezetimibe.

Your doctor will choose an appropriate statin based on factors such as:

  • your age
  • other health conditions you have
  • how much cholesterol-lowering effect you need
  • how well you tolerate a statin
  • other drugs that you take

Age

It’s rare, but some children have a genetic condition that causes their cholesterol levels to be greatly increased. If your child needs to take a statin to lower their cholesterol level, their doctor may recommend one of the following:

  • atorvastatin, for use in children aged 10 to 17 years
  • fluvastatin, for use in children aged 10 to 16 years
  • lovastatin, for use in children aged 10 to 17 years
  • pravastatin, for use in children aged 8 to 18 years
  • rosuvastatin, for use in children aged 7 to 17 years
  • simvastatin, for use in children aged 10 to 17 years

Existing health conditions

Certain health conditions or risks for conditions can factor into your doctor’s recommendation. Your doctor may suggest a high-potency statin therapy, which works more aggressively to lower your cholesterol level, if you:

  • have active heart disease
  • have very high LDL levels (190 mg/dL or greater)
  • are between the ages of 40 and 75 years, with diabetes and an LDL level between 70 mg/dL and 189 mg/dL
  • are between the ages of 40 and 75 years, with an LDL level between 70 mg/dL and 189 mg/dL and a high risk of developing heart disease

Atorvastatin and rosuvastatin are typically used for high-potency statin therapy.

If you can’t tolerate a high-potency statin therapy or if you have diabetes and a lower risk of developing heart disease, your doctor may recommend a moderate-potency statin therapy. This may include:

  • simvastatin
  • pravastatin
  • lovastatin
  • fluvastatin
  • pitavastatin
  • atorvastatin
  • rosuvastatin

Other medications you take

Your doctor will also need to know the other medications you take in order to recommend a statin for you. It’s important to tell your doctor about all drugs you take, including over-the-counter drugs as well as supplements and herbs.

If you take multiple medications, your doctor might recommend a statin that is less likely to interact with other drugs, such as pravastatin and rosuvastatin.

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Takeaway

Talk with your doctor

If you need to take a statin to help lower your cholesterol levels, you have several options. Give your doctor a complete medical history to help them decide the most appropriate statin for you. Important points to discuss include:

  • your cholesterol levels
  • your history or family history of heart disease
  • medications you take
  • any medical conditions you have

All of these factors can affect your ability to take a statin and the statin options available to you. Your doctor should be able to start you on a statin that not only safely improves your cholesterol levels and lowers your risk of heart attack and stroke, but also works well with other medications you take.

You won’t be able to judge whether your statin is working based on how you feel. So, it’s important to keep appointments with your doctor to monitor your statin therapy. Your doctor will perform blood tests that measure your cholesterol levels to make sure your statin is working. Statins usually take 2 to 4 weeks to become fully effective, including after dosage changes.

Talk with your doctor about any side effects that you have. Your doctor may be able to adjust your dosage, switch you to another statin, or stop your statin therapy to give you a different cholesterol-lowering medication.

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