page184
Pravastatin
(Non-proprietary) A
Tablets
,
pravastatin sodium 10 mg,
net price 28-tab
pack = £1.72;
20 mg, 28-tab pack = £2.02; 40 mg, 28-
tab pack = £2.78.
Counselling,
muscle effects,
see
notes above
Lipostat
c
(Squibb) A
Tablets
,
all yellow,
pravastatin sodium 10 mg,
net
price 28-tab pack = £14.18;
20 mg,
28-tab pack =
£26.01;
40 mg,
28-tab pack = £26.01.
Counselling,
muscle effects,
see notes above
ROSUVASTATIN
Indications
primary hypercholesterolaemia (type IIa
including heterozygous familial hypercholesterol-
aemia),
mixed dyslipidaemia (type IIb),
or homozy-
gous familial hypercholesterolaemia in patients who
have not responded adequately to diet and other
appropriate measures;
prevention of cardiovascular
events in patients at high risk of a first cardiovascular
event
Cautions
see notes above; patients of Asian origin (see
under Dose);
max.
dose 20 mg in patients with risk
factors for myopathy or rhabdomyolysis (including
personal
or family history of muscular disorders or
toxicity)
Hepatic impairment
see notes above
Renal impairment
initially 5 mg once daily (do not
exceed 20 mg daily) if eGFR 30–60 mL/minute/
1.73 m
2
;
avoid if eGFR less than 30 mL/minute/
1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also diabetes mellitus;
proteinuria;
very rarely
haematuria
Dose
. Hypercholesterolaemia,
initially 5–10 mg once daily
increased if necessary at intervals of at least 4 weeks
to 20 mg once daily, increased after further 4 weeks to
40 mg daily only in severe hypercholesterolaemia with
high cardiovascular risk and under specialist super-
vision;
ELDERLY
initially 5 mg once daily;
patient of
ASIAN
origin,
initially 5 mg once daily increased if
necessary to max.
20 mg daily
Note
Initially 5 mg once daily with concomitant
fibrate
increased if necessary to max.
20 mg daily
. Prevention of cardiovascular events, 20 mg once daily
Crestor
c
(AstraZeneca) T A
Tablets
,
f/c,
rosuvastatin (as calcium salt) 5 mg (yel-
low), net price 28-tab pack = £18.03; 10 mg (pink), 28-
tab pack = £18.03; 20 mg (pink), 28-tab pack = £26.02;
40 mg (pink), 28-tab pack = £29.69.
Counselling,
muscle effects,
see notes above
SIMVASTATIN
Indications
primary hypercholesterolaemia, homozy-
gous familial hypercholesterolaemia or combined
(mixed) hyperlipidaemia in patients who have not
responded adequately to diet and other appropriate
measures;
prevention of cardiovascular events in
patients with atherosclerotic cardiovascular disease or
diabetes mellitus
Cautions
see notes above; also 80-mg dose only for
those with severe hypercholesterolaemia and at high
risk of cardiovascular complications
Hepatic impairment
see notes above
Renal impairment
doses above 10 mg daily should be
used with caution if eGFR less than 30 mL/minute/
1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also
rarely
anaemia
Dose
. Primary hypercholesterolaemia, combined hyper-
lipidaemia,
10–20 mg daily at night,
adjusted at
intervals of at least 4 weeks; usual range 10–80 mg
once daily at night
. Homozygous familial hypercholesterolaemia, 40 mg
daily at night
or
80 mg daily in 3 divided doses (with
largest dose at night)
. Prevention of cardiovascular events,
initially 20–
40 mg once daily at night,
adjusted at intervals of at
least 4 weeks; max.
80 mg once daily at night
Note
Max. 10 mg daily with concomitant ciclosporin, danazol,
or fibrate (except fenofibrate).
Max.
20 mg daily with conco-
mitant amiodarone or verapamil. Max.
40 mg daily with dilti-
azem or amlodipine
1
Simvastatin
(Non-proprietary) T A
Tablets
,
simvastatin 10 mg,
net price 28-tab pack =
90p, 20 mg, 28-tab pack = £1.01; 40 mg, 28-tab pack =
£1.32;
80 mg,
28-tab pack = £2.29.
Counselling,
muscle effects,
see notes above
Brands include
Simvador
c
Oral suspension
,
simvastatin 20 mg/5 mL, net price
150 mL = £99.50,
40 mg/5 mL,
150 mL = £152.00.
Counselling,
muscle effects,
see notes above
Excipients
may include propylene glycol
1
Zocor
c
(MSD) T A
Tablets
,
all f/c,
simvastatin 10 mg (peach),
net price
28-tab pack = £18.03;
20 mg (tan),
28-tab pack =
£29.69; 40 mg (red), 28-tab pack = £29.69; 80 mg (red),
28-tab pack = £29.69. Counselling, muscle effects, see
notes above
With ezetimibe
Note
For homozygous familial hypercholesterolaemia, primary
hypercholesterolaemia, and mixed hyperlipidaemia in patients
stabilised on the individual components in the same propor-
tions, or for patients not adequately controlled by statin alone.
For prescribing information on ezetimibe,
see Ezetimibe
Inegy
c
(MSD,
Schering-Plough) A
Tablets
, simvastatin 20 mg, ezetimibe 10 mg, net price
28-tab pack = £33.42;
simvastatin 40 mg,
ezetimibe
10 mg,
28-tab pack = £38.98; simvastatin 80 mg,
eze-
timibe 10 mg,
28-tab pack = £41.21.
Counselling,
muscle effects,
see notes above
Bile acid sequestrants
Colesevelam,
colestipol,
and colestyramine are bile
acid sequestrants used in the management
of
hyper-
cholesterolaemia.
They act
by binding bile acids,
pre-
venting their reabsorption;
this promotes hepatic con-
version of
cholesterol
into bile acids;
the resultant
increased LDL-receptor activity of
liver cells increases
the clearance of LDL-cholesterol from the plasma.
Bile
1.
Simvastatin 10 mg tablets can be sold to the public to
reduce
risk
of
first
coronary event
in individuals
at
moderate risk of coronary heart disease (approx.
10–15%
risk of major event in 10 years), max. daily dose 10 mg and
pack size of
28 tablets;
treatment
should form part
of
a
programme to reduce risk of coronary heart disease
164
2.12 Lipid-regulating drugs
BNF 61
2
Cardiovascular system