Statin Medications – A Primer
I am not a proponent of taking a statin to lower cholesterol IF one’s only heart disease risk factor is high cholesterol (see my post, Statin Statin, Do You Really Need A a Statin?) That said, there are millions for whom statin meds are a literal lifesaver. So if you are taking a statin because you have several heart disease risk factors, you might be hankering for some information about the different statin meds on the market. Here’s an overview of the top selling statins in the US.
The most common statins prescribed in the US include: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin (Zocor), Lovastatin (Mevacor), Pravastatin (Pravachol), and Fluvastatin (Lescol).
Available in the US since 1977, Pfizer’s Lipitor is probably the best known and most widely prescribed drug to lower cholesterol. Indeed, in 2010, Lipitor was the #1 selling drug sold in the United States (not #1 cholesterol drug, #1 of ALL drugs), with $7.2 billion in sales. Sales of branded Lipitor declined dramatically after it went off patent in late 2011 (in fact, in 2013 Lipitor fell out of the top 100 drugs sold). That said, millions of Americans still take Lipitor (or have switched to generic Atorvastatin) to lower their cholesterol, and it is a fine statin for many who need to take it.
KEY TO KNOW: It’s vital that anyone taking Lipitor or Atorvastatin avoid eating grapefruit and drinking grapefruit juice. That is because grapefruit boosts absorption of this drug into the bloodstream, which in turn increases the likelihood of potentially serious side effects. Do NOT ingest grapefruit if you take a statin unless you’ve discussed with your doctor.
You probably have figured out that the next big branded cholesterol drug (now that Lipitor is off-patent) is Crestor – their advertising budget appears to be enormous. And it’s working. In 2013, AstraZeneca’s Crestor was the top-selling statin, and the #4 drug sold in the US. But what you might not know is that Crestor is the most potent of all the statin medications. And that means there is a higher likelihood of potentially serious muscle damage risk with Crestor than with other statins. If you take Crestor, it’s extremely important to immediately report any muscle pain or weakness to your doctor.
Merck’s Zocor was one of the top 10 selling drugs in the US through 2006, when it went off patent. Sales of Zocor fell off dramatically as soon as it went off-patent, and they fell even further in June 2011 when the FDA issued new warnings about the dangers of high-dose Zocor or Simvastatin. The warning: that at high doses, this drug is more likely to cause muscle damage. The FDA also issued restrictions for even mid or low-dose simvastatin. The response was that many doctors who used to prescribe Simvastatin have switched their patients to other statins – which explains why Zocor is now out of the top 100 drugs sold, and Simvastatin doesn’t even make that list. Net, Zocor and Simvastatin are likely the right statin for many, but it might be a good time to review statin options with your doctor if you’ve been taking Zocor or Simvastatin for a long time.
Also, key to note that Zocor and Simvastatin also interact with grapefruit, so as with Lipitor, grapefruit and grapefruit juice must be avoided by those taking this statin.
Lovastatin’s claim to fame is that it was the first statin approved for human consumption. The compound was first introduced by Merck scientists in 1978; after Lovastatin they went on to develop Simvastatin, a close chemical derivative of Lovastatin. (Merck branded Simvastatin as Zocor as explained above – and they marketed it more than Mevacor because it had a later patent expiration date.) Lovastatin is not widely prescribed any longer – and has been out of the top 200 in sales in the US since 2005 – but its relevance in the world of statin meds is that it was very the first statin medication.
Discovered by Sankyo scientists in Japan in 1979 and launched in Japan in 1989, Pravachol is a statin that is a modified version of Lovastatin. People with muscle disease who can’t tolerate statins can sometimes tolerate Pravachol. That said, Simvastatin and Atorvastatin are far less expensive options, so Pravachol and Pravastatin are now rarely prescribed in the US.
Key to note: Pravachol and Pravastatin also interact with grapefruit, so as with Lipitor, grapefruit and grapefruit juice must be avoided by those taking this drug.
Lescol or Fluvastatin was introduced by Novartis in the US in 1993. It is the least potent statin – so it’s a good choice for those committed to making lifestyle changes to lower cholesterol but who still need a statin because they have several heart disease risk factors. Also since it’s one of the more mild statins, it is the medication that is often prescribed when a patient cannot tolerate the side effects with other statin medications.
If you have multiple heart disease risk factors and need a statin to reduce cholesterol, ask your doctor why he/she has prescribed that particular statin. They have different potencies and whether you use a generic or branded statin can make a huge difference to your wallet. With any statin, be sure to discuss ALL medications you take with your doctor as these statins react not only with grapefruit (some of them) but also with a wide array of other medications.
Statins can have side effects – sometimes serious. Serious side effects can include liver damage, type 2 diabetes, and muscle problems – which can range from myositis, which is essentially muscle inflammation, to rhabdomylysis, which is extreme muscle inflammation and muscle damage. If you take any statin, be sure to go to your follow up appointments where your liver will be checked — and tell your doctor if you have any muscle pain.
If you are currently taking a statin and you are not sure if you really need it, do some research and then discuss your heart disease risk and medication plan with your doctor. (Of course, you should never stop taking a medication without discussing with your doctor.) For more about calculating heart disease risk, see my Calculate Your Heart Attack Risk Online post.