Annals of Pharmacotherapy · 2008 · 129 citations · 19 references
PharmacyPharmacokineticsPharmacotherapyCardiovascular PharmacotherapyClinical PharmacologyPharmacovigilanceAtherosclerosis PharmacotherapyCardiovascular DiseaseLipid DisordersLipid ManagementLipid-lowering TherapyLipoprotein AnalysisAdverse Treatment EffectsDaily DosingLipid Profile ChangesLow-density Lipoprotein Cholesterol LoweringMedication Adverse EffectsNonstatin Lipid-lowering TherapyOnce-daily Dosing RegimensStatin Adverse Effects
BACKGROUND: Statins are generally well tolerated, but some patients discontinue therapy secondary to adverse effects. Dosing a statin (rosuvastatin) every other day (EOD) may provide significant lipoprotein changes while avoiding common adverse effects in this statin-intolerant population. OBJECTIVE: To determine the effect and tolerance of EOD rosuvastatin in patients previously intolerant to statin therapy. METHODS: We performed a retrospective analysis of patients treated with EOD rosuvastatin at 2 lipid specialty clinics: the University of Kansas Lipid, Atherosclerosis, and LDL-Apheresis Center and the Hartford Hospital Cholesterol Management Center. Approximately 2600 charts were reviewed to identify patients receiving rosuvastatin EOD who previously had experienced statin intolerance. 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. Laboratory data were assessed immediately prior to rosuvastatin EOD therapy and at the first follow-up. RESULTS: Myalgias (76.5%) and increased transaminase levels (19.5%) were the most common causes of prior statin intolerance, but 72.5% (37/51) of patients were able to tolerate the EOD therapy (mean dose 5.6 mg) regimen for 4 +/- 2.9 (mean +/- SD) months. 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. All patients who were considered to be intolerant to rosuvastatin EOD therapy (27.5%; 14/51) re-experienced the symptoms of their prior statin intolerance. CONCLUSIONS: Treating patients intolerant to statins with rosuvastatin EOD was tolerated by the majority of patients and reduced LDL-C in our study. This dosing strategy may be useful in patients intolerant to once-daily statin dosing, although such an approach has not been documented to reduce cardiovascular events.
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Richard C. Pasternak, Sidney C. Smith, Scott M. Grundy et al. · Journal of the American College of Cardiology · 2002 · 494 citations