hmg-coa reductase inhibitors (statins)

REMS

Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias.

Atorvastatin

Primary prevention of cardiovascular disease (↓ risk of MI or stroke) in patients with multiple risk factors for coronary heart disease (CHD) or type 2 diabetes mellitus (also ↓ risk of angina or revascularization procedures in patients with multiple risk factors for CHD).

Atorvastatin and pravastatin

Secondary prevention of cardiovascular disease (↓ risk of MI, stroke, revascularization procedures, angina, and hospitalizations for HF) in patients with clinically evident CHD.

Fluvastatin

Secondary prevention of coronary revascularization procedures in patients with clinically evident CHD.

Fluvastatin and lovastatin

Slow progression of coronary atherosclerosis in patients with CHD.

Lovastatin

Primary prevention of CHD (↓ risk of MI, unstable angina, and coronary revascularization) in patients without symptomatic cardiovascular disease with ↑ total and low-density lipoprotein cholesterol (LDL-C) and ↓ high-density lipoprotein cholesterol (HDL-C).

Pravastatin

Primary prevention of CHD (↓ risk of MI, coronary revascularization, and cardiovascular mortality) in patients without clinically evident CHD.

Simvastatin

Secondary prevention of cardiovascular events (↓ risk of MI, coronary revascularization, stroke, and cardiovascular mortality) in patients with clinically evident CHD or those at high-risk for CHD (history of diabetes, peripheral arterial disease, or stroke).

Rosuvastatin

Slow progression of coronary atherosclerosis.

Rosuvastatin

To reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal MI, nonfatal stroke, or an arterial revascularization procedure) in patients without established coronary heart disease who are at increased risk of cardiovascular disease based on age, high-sensitivity C-reactive protein ≥2 mg/L, and at least one additional cardiovascular risk factor.

Rosuvastatin

Adjunctive therapy to diet and exercise for the reduction of LDL-C in children 8–17 yr with heterozygous familial hypercholesterolemia if after diet therapy fails the following still exist: LDL-C remains >190 mg/dL or remains >160 mg/dL (with family history of premature cardiovascular disease or ≥2 risk factors for cardiovascular disease).

Action ⬆ ⬇

Inhibit an enzyme, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which is responsible for catalyzing an early step in the synthesis of cholesterol.

Therapeutic effects:

Lower total and LDL-C and triglycerides. Slightly increase HDL-C.
Slow the progression of coronary atherosclerosis with resultant decrease in CHD-related events.

Pharmacokinetics ⬆ ⬇

Absorption: Atorvastatin: Rapidly absorbed but undergoes extensive GI and hepatic metabolism, resulting in 14% bioavailability; Fluvastatin: 98% absorbed after oral administration, but undergoes extensive first-pass metabolism resulting in 24% bioavailability; Lovastatin, pravastatin: Poorly and variably absorbed after oral administration; Pitavastatin: well absorbed (51%) after oral administration; Rosuvastatin: 20% absorbed following oral administration; Simvastatin: 85% absorbed but rapidly metabolized.

Distribution: Atorvastatin: probably enters breast milk. Fluvastatin: enters breast milk. Lovastatin: crosses the blood-brain barrier and placenta. Pravastatin: small amounts enter breast milk. Pitavastatin, rosuvastatin, and simvastatin: unknown.

Protein Binding: Atorvastatin, fluvastatin, pitavastatin, and simvastatin: >98%.

Metabolism/Excretion: All agents are extensively metabolized by the liver; amount excreted unchanged in urine: Atorvastatin:<2%, Lovastatin: 10%, Fluvastatin: 5%, Pitavastatin: 15%, Pravastatin: 20%, and Simvastatin: 13%.

Half-Life: Atorvastatin: 14 hr; Fluvastatin: 1.2 hr; Lovastatin: 3 hr; Pitavastatin: 12 hr; Pravastatin: 1.3–2.7 hr; Rosuvastatin: 19 hr; Simvastatin: unknown.

Time/Action Profile ⬆ ⬇

( cholesterol-lowering effect)

ROUTE	ONSET	PEAK	DURATION*
Atorvastatin	unknown	unknown	20–30 hr
Fluvastatin	1–2 wk	4–6 wk	unknown
Lovastatin	2 wk	4–6 wk	6 wk
Pitavastatin	within 4 wk	4 wk	unknown
Pravastatin	several days	2–4 wk	unknown
Rosuvastatin	unknown	2–4 wk	unknown
Simvastatin	several days	2–4 wk	unknown

* After discontinuation.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Active liver failure or decompensated cirrhosis;
Simvastatin and lovastatin: Concurrent use of strong CYP3A4 inhibitors (↑ risk of myopathy/rhabdomyolysis);
Pitavastatin: Concurrent use of cyclosporine;
Pitavastatin: severe renal impairment;
Simvastatin: Concurrent use of cyclosporine, gemfibrozil, or danazol (↑ risk of myopathy/rhabdomyolysis);
Simvastatin: Chinese patients receiving ≥1 g/day of niacin (↑ risk of myopathy);
Lactation: Lactation.

Use Cautiously in:

History of liver disease;
Alcoholism;
Rosuvastatin: Patients with Asian ancestry (may have ↑ blood levels and ↑ risk of rhabdomyolysis);
Pitavastatin:Hypothyroidism (higher risk of myopathy/rhabdomyolysis);
Renal impairment;
OB: Use statin therapy during pregnancy only if potential maternal benefit justifies potential fetal risk (if needed, consider using a more water-soluble agent [pravastatin or rosuvastatin] that is less likely to cross the placenta);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children <18 yr (fluvastatin, pitavastatin), <10 yr (atorvastatin, lovastatin, simvastatin), or <8 yr (pravastatin, rosuvastatin);
Geri: Atorvastatin and pitavastatin:↑ risk of myopathy in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain, peripheral edema

Derm: rash, pruritus

EENT: rhinitis, blurred vision (lovastatin)

Endo: hyperglycemia

GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, ↑liver enzymes, altered taste, drug-induced hepatitis, dyspepsia, nausea, pancreatitis

GU: erectile dysfunction

MS: arthralgia, arthritis, immune-mediated necrotizing myopathy (IMNM), myalgia, myopathy (↑ with simvastatin 80 mg/day dose), RHABDOMYOLYSIS

Neuro: amnesia, confusion, dizziness, headache, insomnia, memory loss, weakness

Resp: bronchitis

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA AND URTICARIA)

Interactions ⬆ ⬇

Atorvastatin, lovastatin, simvastatin, and rosuvastatin are metabolized by the CYP3A4 metabolic pathway. Fluvastatin is metabolized by CYP2C9. Pravastatin is not metabolized by the CYP P450 system.

Drug-drug:

Risk of myopathy with lovastatin is ↑ by strong CYP3A4 inhibitors, including ketoconazole, itraconazole, posaconazole, voriconazole protease inhibitors, clarithromycin, erythromycin, nefazodone, and cobicistat-containing products; concurrent use contraindicated.
Risk of myopathy with simvastatin is ↑ by cyclosporine, gemfibrozil, danazol, erythromycin, clarithromycin, protease inhibitors, nefazodone, ketoconazole, itraconazole, voriconazole, posaconazole, and cobicistat-containing products; concurrent use contraindicated.
Risk of myopathy with pitavastatin is ↑ by cyclosporine; concurrent use contraindicated.
Bioavailability and effectiveness may be ↓ by cholestyramine and colestipol.
Risk of myopathy with atorvastatin is ↑ by clarithromycin, colchicine, cyclosporine, darunavir/ritonavir, elbasvir/grazoprevir, erythromycin, fosamprenavir, fosamprenavir/ritonavir gemfibrozil, glecaprevir/pibrentasvir, itraconazole, ledipasvir/sofosbuvir, letermovir, lopinavir/ritonavir, nelfinavir, niacin (>1 g/day), or tipranavir/ritonavir; avoid concurrent use with cyclosporine, gemfibrozil, glecaprevir/pibrentasvir, or tipranavir/ritonavir; use lowest dose with lopinavir/ritonavir; use ↓ doses with clarithromycin, darunavir/ritonavir, elbasvir/grazoprevir, fosamprenavir, fosamprenavir/ritonavir, itraconazole, letermovir, or nelfinavir.
Risk of myopathy with fluvastatin is ↑ by gemfibrozil, erythromycin, colchicine, cyclosporine, azole antifungal agents, or large doses of niacin; avoid concurrent use with gemfibrozil; use ↓ doses with cyclosporine and fluconazole.
Risk of myopathy with lovastatin is ↑ by amiodarone cyclosporine, gemfibrozil, diltiazem, verapamil, danazol, and large doses of niacin; avoid concurrent use with gemfibrozil or cyclosporine; use ↓ doses with danazol, amiodarone, diltiazem, or verapamil.
Risk of myopathy with pitavastatin is ↑ by erythromycin, rifampin, colchicine, fibrates, or large doses of niacin; avoid concurrent use with gemfibrozil; use ↓ doses with erythromycin, rifampin, and niacin.
Risk of myopathy with pravastatin is ↑ by cyclosporine, fibrates, colchicine, erythromycin, clarithromycin, azithromycin, or large doses of niacin; avoid concurrent use with gemfibrozil; consider lower dose with niacin.
Risk of myopathy with rosuvastatin is ↑ by atazanavir/ritonavir, capmatinib, colchicine, cyclosporine, darolutamide, dasabuvir/ombitasvir/paritaprevir/ritonavir, elbasvir/grazoprevir, enasidenib, febuxostat, fibrates, fostamatinib, glecaprevir/pibrentasvir, lopinavir/ritonavir, niacin (large doses), regorafenib, sofosbuvir/velpatasvir, tafamidis, teriflunomide, and ticagrelor; avoid concurrent use with gemfibrozil; use ↓ doses with atazanavir/ritonavir, capmatinib, cyclosporine, darolutamide, dasabuvir/ombitasvir/paritaprevir/ritonavir, elbasvir/grazoprevir, enasidenib, fostamatinib, glecaprevir/pibrentasvir, lopinavir/ritonavir, regorafenib, sofosbuvir/velpatasvir, tafamidis, and teriflunomide.
Risk of myopathy with simvastatin is ↑ by amiodarone, amlodipine, daptomycin, diltiazem, dronedarone, verapamil, ranolazine, lomitapide, or niacin; avoid concurrent use with niacin at doses of ≥1 g/day in Chinese patients; temporarily suspend simvastatin therapy during treatment with daptomycin; use ↓ doses with amiodarone, amlodipine, diltiazem, dronedarone, lomitapide, ranolazine, or verapamil.
Atorvastatin, fluvastatin, and simvastatin may slightly ↑ digoxin levels.
Atorvastatin and rosuvastatin may ↑ levels and risk of toxicity of hormonal contraceptives.
Atorvastatin, fluvastatin, lovastatin, rosuvastatin, and simvastatin may ↑ risk of bleeding with warfarin.
Alcohol, cimetidine, and omeprazole may ↑ levels and risk of toxicity of fluvastatin.
Rifampin may ↓ levels and effectiveness of fluvastatin.
Antacids may ↓ absorption of rosuvastatin; administer 2 hr after rosuvastatin.
Fluvastatin ↑ levels of and risk of hypoglycemia with glyburide.

Drug-Natural Products:

St. John's wort may ↓ levels and effectiveness of lovastatin and simvastatin.

Drug-Food:

Large quantities of grapefruit juice may ↑ levels and risk of rhabdomyolysis with atorvastatin, lovastatin, and simvastatin; concurrent use contraindicated.
Food↑ levels of lovastatin.

Route/Dosage ⬆ ⬇

Atorvastatin

PO (Adults ): 10–20 mg once daily initially; may start with 40 mg/day if LDL-C needs to be ↓ by >45%; may ↑ every 2–4 wk up to 80 mg/day; Concurrent use of nelfinavir: Dose should not exceed 40 mg/day; Concurrent use of clarithromycin, itraconazole, letermovir, darunavir/ritonavir, fosamprenavir, fosamprenavir/ritonavir, or elbasvir/grazoprevir: Dose should not exceed 20 mg/day.
PO (Children ≥10 yr): 10 mg/day initially; may ↑ every 4 wk up to 20 mg/day; Concurrent use of nelfinavir: Dose should not exceed 40 mg/day; Concurrent use of clarithromycin, itraconazole, darunavir/ritonavir, fosamprenavir, fosamprenavir/ritonavir therapy, or elbasvir/grazoprevir: Dose should not exceed 20 mg/day.

Fluvastatin

PO (Adults ): 20–40 mg (immediate release) once daily at bedtime. May ↑ to 40 mg twice daily (immediate release) or 80 mg once daily (extended release); Concurrent use of fluconazole or cyclosporine: Dose should not exceed 20 mg twice daily.

Lovastatin

PO (Adults ): 20 mg once daily with evening meal. May ↑ at 4-wk intervals to a maximum of 80 mg/day; Concurrent use of danazol, verapamil, or diltiazem: Initiate at 10 mg once daily; do not exceed 20 mg/day; Concurrent use of amiodarone: Dose should not exceed 40 mg/day.
PO (Children ≥10 yr): Familial heterozygous hypercholesterolemia: 10–40 mg/day adjusted at 4-wk intervals.

Renal Impairment

PO (Adults ): CCr <30 mL/min: Dose should not exceed 20 mg/day unless carefully titrated.

Pitavastatin

PO (Adults ): 2 mg once daily initially; may ↑ up to 4 mg once daily depending on response. Concurrent erythromycin therapy: Dose should not exceed 1 mg/day; Concurrent use of rifampin: Dose should not exceed 2 mg/day.

Renal Impairment

PO (Adults ): CCr 30–<60 mL/min: 1 mg once daily initially; may ↑ up to 2 mg daily.

Pravastatin

PO (Adults ): 40 mg once daily at bedtime; may ↑ after 4 wk, if needed to 80 mg once daily at bedtime; Concurrent use of cyclosporine: Initiate therapy with 10 mg once daily at bedtime; may ↑ after 4 wk, if needed, to 20 mg once daily at bedtime (max dose = 20 mg/day); Concurrent use of clarithromycin: Dose should not exceed 40 mg/day.
PO (Children 14–18 yr): 40 mg once daily (max dose = 40 mg/day).
PO (Children 8–13 yr): 20 mg once daily (max dose = 20 mg/day).

Renal Impairment

PO (Adults ): CCr <30 mL/min: Initiate therapy with 10 mg once daily at bedtime; may titrate at 4-wk intervals as needed (max dose = 80 mg/day).

Rosuvastatin

PO (Adults ): 10 mg once daily initially (range 5–20 mg initially) (20 mg initial dose may be considered for patients with LDL-C >190 mg/dL or homozygous familial hypercholesterolemia); dose may be adjusted at 2–4 wk intervals, some patients may require up to 40 mg/day, however this dose is associated with ↑ risk of rhabdomyolysis; Patients with Asian ancestry: Initial dose should be 5 mg; Concurrent use of cyclosporine or darolutamide: Dose should not exceed 5 mg/day. Concurrent use of capmatinib, enasidenib, regorafenib, or teriflunomide: Dose should not exceed 10 mg/day. Concurrent use of gemfibrozil: Avoid concurrent use. If concurrent use necessary, initiate at 5 mg once daily; dose should not exceed 10 mg/day. Concurrent use of atazanavir/ritonavir, dasabuvir/ombitasvir/paritaprevir/ritonavir, elbasvir/grazoprevir, glecaprevir/pibrentasvir, lopinavir/ritonavir, or sofosbuvir/velpatasvir: Initial dose should be 5 mg once daily; dose should not exceed 10 mg/day. Concurrent use of tafamidis: Avoid concurrent use. If concurrent use necessary, initiate at 5 mg once daily; dose should not exceed 20 mg/day.
PO (Children 10–17 yr): Heterozygous familial hypercholesterolemia: 5–20 mg once daily; Patients with Asian ancestry: Initial dose should be 5 mg; Concurrent use of cyclosporine: Dose should not exceed 5 mg/day; Concurrent use of atazanavir/ritonavir, glecaprevir/pibrentasvir, lopinavir/ritonavir, or sofosbuvir/velpatasvir: Dose should not exceed 10 mg/day.
PO (Children 8–<10 yr): Heterozygous familial hypercholesterolemia: 5–10 mg once daily; Patients with Asian ancestry: Initial dose should be 5 mg; Concurrent use of cyclosporine: Dose should not exceed 5 mg/day; Concurrent use of atazanavir/ritonavir, lopinavir/ritonavir, or sofosbuvir/velpatasvir: Dose should not exceed 10 mg/day.
PO (Children 7–17 yr): Homozygous familial hypercholesterolemia: 20 mg once daily. Patients with Asian ancestry: Initial dose should be 5 mg; Concurrent use of cyclosporine: Dose should not exceed 5 mg/day; Concurrent use of atazanavir/ritonavir, lopinavir/ritonavir, or sofosbuvir/velpatasvir: Dose should not exceed 10 mg/day.

Renal Impairment

PO (Adults ): CCr <30 mL/min: 5 mg once daily initially; dose may be ↑ but should not exceed 10 mg/day.

Simvastatin

The 80-mg dose should be restricted to patients who have been taking this dose for ≥12 mo without evidence of muscle toxicity
PO (Adults ): 20–40 mg once daily in the evening; if LDL-C goal cannot be achieved with 40 mg/day dose, add another lipid-lowering therapy (do not ↑ simvastatin dose to 80 mg/day). Concurrent use of verapamil, diltiazem, or dronedarone: Dose should not exceed 10 mg/day. Concurrent use of amiodarone, amlodipine, or ranolazine: Dose should not exceed 20 mg/day; Concurrent use of lomitapide:↓ dose by 50% (dose should not exceed 20 mg/day or 40 mg/day for patients who previously received 80 mg/day chronically [for ≥12 mo] without evidence of myopathy).
PO (Children 10–17 yr): 10 mg once daily in the evening initially; may ↑ at 4-wk intervals up to 40 mg/day. Concurrent use of verapamil or diltiazem: Dose should not exceed 10 mg/day. Concurrent use of amiodarone, amlodipine, or ranolazine: Dose should not exceed 20 mg/day.

Renal Impairment

PO (Adults ): CCr 15–29 mL/min: 5 mg once daily in the evening initially, titrate carefully.

Availability ⬆ ⬇

Atorvastatin

(Generic available)

Tablets: 10 mg; 20 mg; 40 mg; 80 mg
Oral suspension orange flavor: 20 mg/5 mL
In combination with:
amlodipine (Caduet). See Combination Drugs.

Fluvastatin

(Generic available)

Immediate-release capsules: 20 mg; 40 mg
Extended-release tablets: 80 mg

Lovastatin

(Generic available)

Immediate-release tablets:: 10 mg; 20 mg; 40 mg

Pitavastatin

(Generic available)

Tablets: 1 mg; 2 mg; 4 mg

Pravastatin

(Generic available)

Tablets: 10 mg; 20 mg; 40 mg; 80 mg

Rosuvastatin

(Generic available)

Tablets (Crestor): 5 mg; 10 mg; 20 mg; 40 mg
Sprinkle capsules (Ezallor): 5 mg; 10 mg; 20 mg; 40 mg
In combination with:
ezetimibe (Roszet). See Combination Drugs.

Simvastatin

(Generic available)

Tablets (Zocor): 5 mg; 10 mg; 20 mg; 40 mg; 80 mg
Oral suspension (FloLipid): 20 mg/5 mL; 40 mg/5 mL
In combination with:
ezetimibe (Vytorin). See Combination Drugs.

Assessment ⬆ ⬇

Obtain a dietary history, especially with regard to fat consumption.
Monitor for signs/symptoms of myopathy or rhabdomyolysis (malaise, myalgia, muscle cramps or weakness, dark or tea-colored urine). Predisposing factors for myopathy include ≥65 yr, female patients, uncontrolled hypothyroidism, and renal impairment. Asian patients may be at ↑ risk for myopathy.
Pedi: In pediatric patients, monitor growth, development (with Tanner staging), and sexual maturation during therapy.

Lab Test Considerations:

Monitor lipid panel (total cholesterol, HDL-C, LDL-C, triglycerides) at baseline, after 2–4 wk of therapy, 2–4 wk after dose adjustments, and periodically.
- Monitor liver function tests, including AST and ALT, before initiating therapy and if signs of liver injury (fatigue, anorexia, right upper abdominal discomfort, dark urine, jaundice) occur. May also ↑ alkaline phosphatase and bilirubin levels.
- If patient develops muscle tenderness during therapy, monitor CK levels. If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued. Monitor for signs and symptoms of IMNM (proximal muscle weakness, ↑ serum CK), persisting despite discontinuation of statin therapy. Perform muscle biopsy to diagnose; shows necrotizing myopathy without significant inflammation. Treat with immunosuppressive agents.
- May ↑ A1c.

Implementation ⬆ ⬇

Do not confuse Lipitor with lisinopril or Zyrtec. Do not confuse Zocor with Cozaar or Zyrtec. Do not confuse atorvastatin with atomoxetine. Do not confuse pravastatin with pitavastatin. Do not confuse HMG-CoA reductase inhibitors (“statins”) with nystatin.
PO: Administer lovastatin with food. Administration on an empty stomach ↓ absorption by approximately 30%. Initial once-daily dose is administered with the evening meal.
- Administer extended-release tablets at bedtime. DNC: Extended-release tablets should be swallowed whole; do not break, crush, chew, or open capsules.
- Administer fluvastatin, pravastatin, and simvastatin once daily in the evening without regard to food. Do not administer two 40-mg fluvastatin tablets at one time (should be 2 divided doses/day). Atorvastatin, pitavastatin, and rosuvastatin can be administered any time of day without regard to food.
- Use a calibrated measuring device to ensure accurate dosing of atorvastatin and simvastatin oral suspensions. Shake well before using. Administer once daily at any time of day, only on an empty stomach (1 hr before or 2 hr after a meal). Use the 40-mg/5-mL strength for doses of ≥40 mg simvastatin oral suspension.
- Administer Ezallor Sprinkle (rosuvastatin) as a single dose at any time of day without regard to food. DNC: Swallow capsules whole; do not crush or chew. For patients who cannot swallow capsules, they may be opened, emptied, and swallowed along with a small amount (1 teaspoon) of soft food, such as applesauce or pudding, without chewing within 60 min.
- Ezallor Sprinkle (rosuvastatin) may be administered via 16-French nasogastric tube. Open the capsule and empty the intact granules into a 60-mL catheter tipped syringe and add 40 mL of water. Replace the plunger and shake the syringe vigorously for 15 seconds; the granules may start dissolving. Deliver the contents of the syringe immediately through the nasogastric tube; then flush with 20 mL of additional water. Use with any other liquids not recommended.
- Avoid grapefruit and grapefruit juice during therapy; may ↑ risk of toxicity.
- If fluvastatin or pravastatin is administered in conjunction with bile acid sequestrants (cholestyramine, colestipol), administer ≥4 hr after bile acid sequestrant.
- If rosuvastatin is administered concurrently with magnesium or aluminum-containing antacids, administer antacid ≥2 hr after rosuvastatin.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of statins. Instruct to take as directed and not to skip doses or double up on missed doses. Take missed doses as soon as remembered but not if <12 hr before next dose. Advise patient to avoid drinking more than 1 quart of grapefruit juice/day during therapy. Medication helps control but does not cure ↑ serum cholesterol levels. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects.
Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.
Instruct patient to notify health care provider if unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise, or signs and symptoms of liver injury (fatigue, anorexia, right upper abdominal discomfort, dark urine, jaundice) occur.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications, especially St. John’s wort.
Inform patient that statins may ↑ A1c. Advise patient to maintain lifestyle measures (regular exercise, maintaining healthy body weight, making healthy food choices).
Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions (rare).
Advise patient to notify health care provider of medication regimen before treatment or surgery.
Rep: Advise patient to notify health care provider promptly if pregnancy is planned or suspected. Use statin therapy during pregnancy only if potential maternal benefit justifies potential fetal risk (if needed, consider using a more water-soluble agent [pravastatin or rosuvastatin] that is less likely to cross the placenta). Advise patients to avoid breastfeeding during therapy.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆