29 Nov statin dose comparison chart
80 mg/day, 33% reduction. -Active liver disease, which may include unexplained persistent elevations in hepatic transaminase levels -Take orally once a day in the evening Maximum dose: 40 mg/day 40 mg/day, 27% reduction. The suspension should be taken in the evening on an empty stomach. -Chinese patients may be a higher risk of myopathy and should be closely monitored Maintenance dose: 5 to 40 mg orally once a day -Concomitant administration of strong CYP450 3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, nefazodone, and cobicistat containing products) -Patients with severe renal impairment should be closely monitored Storage: 80 mg dose should be limited to patients who have been taking it for ≥ 12 months without muscle toxicity. Comments: -Pregnancy -Exposure to this drug is approximately doubled with concomitant use of lomitapide; therefore, if initiating lomitapide, reduce simvastatin by 50% or for patients who have tolerated 80 mg/day chronically, simvastatin should be decreased to 40 mg/day. -Coadministration with Niacin 1 g/day or more: Not recommended for Chinese patients Last updated on Oct 6, 2020. Administration advice: Dosage adjustment may be needed based on renal function, race, or drug interactions. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Capsules may be opened and granules sprinkled on a teaspoon of soft food such as applesauce or chocolate/vanilla flavored pudding. -Substantial alcohol ingestion and/or past history of liver disease: Use with caution -High-risk patients may initiate at 40 mg orally once a day -Patients should understand the risk of myopathy and should be instructed to report unexplained muscle pain promptly, especially if accompanied by malaise or fever. pravastatin or rosuvastatin); consider routine CK monitoring. -Lactation For reductions in LDL of ≥ 20%, starting dose should be 20 mg/day. Applies to the following strengths: 80 mg; 5 mg; 10 mg; 20 mg; 40 mg; 20 mg/5 mL; 40 mg/5 mL. Maximum dose: 40 mg/day. Select one or more newsletters to continue. -High-risk patients may initiate at 40 mg orally once a day. Uses: As an adjunct to diet to reduce total-C, LDL-C, and Apo B levels in adolescent boys and girls who are at least one year postmenarche (10 to 17 years) with heterozygous familial hypercholesterolemia (HeFH), if after an adequate trial of diet therapy the following findings are present: -Doses should be individualized according to the goal of therapy; dose adjustments should be made at intervals of 4 weeks or more. CONTRAINDICATIONS: Capsules should be swallowed whole. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. -Periodic creatine kinase determinations may be considered to monitor for myopathy, however, there is no assurance that such monitoring will prevent myopathy Patient advice: Medically reviewed by Drugs.com. Do not crush or chew. 40 mg orally once a day May be given once daily or in two divided doses. Rosuvastatin** (Crestor) $15 -- 5 to 10mg 20 to 40mg Max dose of 10mg for patients with CrCl <30 mL/min, not on hemodialysis. Simvastatin ^(Zocor) $2 10mg 20 to 40mg -- Initial dose of 5mg in severe renal insufficiency. Initial dose: 10 mg orally once a day in the evening 50 First, although this can be considered something of a class effect, the true risk of each specific statin is still unknown. Muscle cell damage. Grouping of statins used in this guideline: reduction in LDL cholesterol by daily dose. Interrupt therapy if serious liver injury with clinical symptoms and/or hyperbilirubinemia or jaundice develop; investigate cause, if an alternative etiology is not found, do not restart, Restricted Use of Simvastatin 80 mg/day: -Patients should be instructed to report any symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine, or jaundice. -Concomitant administration of gemfibrozil, cyclosporine, or danazol -Patients should be instructed to discuss all medication use including herbal products and over the counter products with their healthcare professional; patients should be advised to avoid grapefruit juice during therapy. -High risk patients include those at high risk for coronary heart disease (CHD) events due to existing CHD, diabetes, peripheral vessel disease, history of stroke or other cerebrovascular disease; in these patients, therapy can be initiated at a higher dose simultaneously with diet (restricted in saturated fat and cholesterol). Statins have been shown to increase the risk of diabetes development, although several important caveats exist. We comply with the HONcode standard for trustworthy health information -, Heterozygous Familial Hypercholesterolemia. -Shake well for at least 20 seconds before measuring dose Use: To reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia (HoFH) as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) or if such treatments are unavailable. -Coadministration with Verapamil, Diltiazem, or Dronedarone: Simvastatin dose should not exceed 10 mg/day A starting dose of 10 mg/day may be considered for patients requiring smaller reductions. Initial dose: 10 to 20 mg orally once a day Impaired renal or … Very rarely, high-dose statin use can cause muscle cells to break down and release a protein called myoglobin into the bloodstream. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. --LDL cholesterol remains 160 mg/dL or greater and there is a positive family history of premature cardiovascular disease (CVD), OR two or more other CVD risk factors are present, Mild to moderate renal dysfunction: No adjustment recommended Food decreases absorption. Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC): Combo 'Polypill' May Cut Heart Attack, Stroke Risk Up to 40%, Computer 'Nudge' Spurs Doctors to Prescribe Statins to Heart Patients, Statins Going Generic Saved Medicare Billions. -Normal Function SLCO1B1 Phenotype: Follow prescribed dosing guidelines and adjust doses based on disease-specific guidelines Maximum dose: 40 mg/day Usual Adult Dose for Prevention of Cardiovascular Disease Initial dose: 10 mg or 20 mg orally once a day -An initial dose of 40 mg may be used in patients who require a larger reduction in low density lipoprotein (e.g. Zetia, atorvastatin, Jardiance, simvastatin, Brilinta, fenofibrate, Lopid, Xarelto, rosuvastatin, Lipitor. Consult WARNINGS section for dosing related precautions. Statin Dose Comparison The chart below shows statin doses expected to provide similar LDL reduction. --LDL cholesterol remains 190 mg/dL or greater, OR When choosing a statin dose, expected LDL reduction is not the only factor to consider. -Patients should be advised to adhere to a diet and exercise program. -Simvastatin 80 mg dose should only be used in patients who have taken this dose chronically (e.g., for 12 months or more) without evidence of muscle toxicity This can lead to severe muscle pain and kidney damage. --This drug is indicated in patients at high risk of CHD events: to reduce the risk of total mortality by reducing CHD deaths; to reduce the risk of nonfatal myocardial infarction and stroke; and to reduce the need for coronary and non-coronary revascularization procedures. Uses: As one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia, specifically: For patients requiring > 55% LDL reduction, recommended starting dose is 10/40 mg/day, Due to increased risk of myopathy, the 10/80 mg dose should be restricted to patients who have been taking 10/80 mg chronically (> 12 months) without evidence of muscle toxicity, All statins carry warnings against use in patients with active liver disease, In general, statins have been found to be safe in patients with liver disease, and they may even be beneficial in nonalcoholic fatty liver disease [32,33], Statins appear to be safe to use and do not cause progression of liver disease in patients with fatty liver disease or chronic hepatitis C. On that basis, there is no need to avoid statin therapy in patients with stable chronic liver disease and normal or modestly elevated transaminases (up to 3 X ULN), There are no reliable data showing that statins are safe in advanced or decompensated liver disease , Reference: [Manufacturer's PI, CYP and transporter pages, 6 ], OATP - Organic anion transporting polypeptide, Pricing based on one month of therapy at standard dosing in an adult, Pricing based on information from GoodRX.com®, Pricing may vary by region and availability, 4 - PMID 27754879 - AHA statin interaction recommendations. Restricted Use (due to myopathy risk): 80 mg/day should only be used in patients who have been taking this drug chronically (e.g. Maximum dose: 40 mg orally once a day in the evening Data sources include IBM Watson Micromedex (updated 2 Nov 2020), Cerner Multum™ (updated 2 Nov 2020), ASHP (updated 23 Oct 2020) and others.
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