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ATORVASTATIN
Indications
primary hypercholesterolaemia, hetero-
zygous familial hypercholesterolaemia,
homozygous
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
type 2 diabetes and at least one additional risk factor
for cardiovascular disease
Cautions
see notes above; also haemorrhagic stroke
Hepatic impairment
see notes above
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also chest pain; back
pain;
less commonly
anorexia,
malaise,
weight gain,
hypoglycaemia,
hyperglycaemia,
tinnitus;
rarely
cho-
lestatic jaundice, peripheral oedema;
very rarely
taste
disturbances,
gynaecomastia,
hearing loss,
Stevens-
Johnson Syndrome,
and toxic epidermal necrolysis
Dose
. Primary hypercholesterolaemia and combined
hyperlipidaemia,
usually 10 mg once daily; if neces-
sary, may be increased at intervals of at least 4 weeks
to max.
80 mg once daily;
CHILD
10–17 years usually
10 mg once daily (limited experience with doses
above 20 mg daily)
. Familial hypercholesterolaemia, initially 10 mg daily,
increased at intervals of at least 4 weeks to 40 mg
once daily;
if necessary,
further increased to max.
80 mg once daily (or 40 mg once daily combined with
anion-exchange resin in heterozygous familial hyper-
cholesterolaemia);
CHILD
10–17 years initially 10 mg
daily,
increased if necessary after at least 4 weeks to
20 mg once daily (limited experience with higher
doses)
. Prevention of cardiovascular events in type 2 dia-
betes,
10 mg once daily
Note
Max.
10 mg daily with concomitant
ciclosporin;
max.
20 mg daily (or temporarily discontinue atorvastatin) with
concomitant clarithromycin; max.
40 mg daily (or temporarily
discontinue atorvastatin) with concomitant itraconazole
Lipitor
c
(Pfizer) A
Tablets,
all f/c,
atorvastatin (as calcium trihydrate)
10 mg,
net price 28-tab pack = £13.00;
20 mg,
28-tab
pack = £24.64; 40 mg 28-tab pack = £24.64; 80 mg, 28-
tab pack = £28.21.
Counselling,
muscle effects,
see
notes above
FLUVASTATIN
Note
The
Scottish Medicines Consortium
(p.
4)
has advised
(February 2004) that fluvastatin is accepted for restricted use
for the secondary prevention of coronary events after percu-
taneous coronary angioplasty;
if the patient has previously
been receiving another statin, then there is no need to change
the statin
Indications
adjunct to diet in primary hyper-
cholesterolaemia or combined (mixed) hyperlipid-
aemia (types IIa and IIb);
adjunct to diet to slow
progression of coronary atherosclerosis in primary
hypercholesterolaemia and concomitant coronary
heart disease; prevention of coronary events after
percutaneous coronary intervention
Cautions
see notes above
Hepatic impairment
see notes above
Renal impairment
manufacturer advises doses above
40 mg daily should be initiated 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
very rarely
vascu-
litis
Dose
. Hypercholesterolaemia or combined hyperlipidaemia,
initially 20–40 mg daily in the evening,
adjusted at
intervals of at least 4 weeks; up to 80 mg daily may be
required;
CHILD
under 18 years, see
BNF for Children
. Prevention of progression of coronary atherosclerosis,
40 mg daily in the evening
. Following percutaneous coronary intervention, 80 mg
daily
Fluvastatin
(Non-proprietary) A
Capsules
, fluvastatin (as sodium salt) 20 mg, net price
28-cap pack = £5.03;
40 mg,
28-cap pack = £5.36.
Counselling,
muscle effects,
see notes above
Lescol
c
(Novartis) A
Capsules
, fluvastatin (as sodium salt) 20 mg (brown/
yellow), net price 28-cap pack = £15.26;
40 mg
(brown/orange), 28-cap pack = £15.26, 56-cap pack =
£30.53.
Counselling,
muscle effects,
see notes above
Modified release
Lescol
c
XL
(Novartis) A
Tablets
,
m/r,
yellow,
fluvastatin (as sodium salt)
80 mg,
net price 28-tab pack = £19.20.
Label:
25,
counselling,
muscle effects,
see notes above
Dose
80 mg once daily (dose form not appropriate for initial dose
titration in hypercholesterolaemia or combined hyperlipidaemia)
PRAVASTATIN SODIUM
Indications
adjunct to diet for primary hyper-
cholesterolaemia or combined (mixed) hyperlipidae-
mias in patients who have not responded adequately
to dietary control; adjunct to diet to prevent cardio-
vascular events in patients with hypercholesterol-
aemia; prevention of cardiovascular events in patients
with previous myocardial infarction or unstable
angina;
reduction of hyperlipidaemia in patients
receiving immunosuppressive therapy following solid-
organ transplantation
Cautions
see notes above
Hepatic impairment
see notes above
Renal impairment
manufacturer advises initial dose
of 10 mg once daily in moderate to severe impairment
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
less commonly
abnor-
mal urination (including dysuria,
nocturia and fre-
quency);
very rarely
fulminant hepatic necrosis
Dose
. Hypercholesterolaemia or combined hyperlipidae-
mias, 10–40 mg once daily at night, adjusted at inter-
vals of at least 4 weeks
. Familial hypercholesterolaemia,
CHILD
8–14 years 10–
20 mg once daily at night, 14–18 years 10–40 mg once
daily at night
. Prevention of cardiovascular events, 40 mg once daily
at night
. Post-transplantation hyperlipidaemia,
initially 20 mg
once daily at night,
increased if necessary (under
close medical supervision) to max.
40 mg once daily
at night
BNF 61
2.12 Lipid-regulating drugs
163
2
Cardiovascular system