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Statins are lipid-lowering drugs that stabilize and reverse atherosclerotic plaques and significantly reduce the risk of cardiovascular death. Commonly used statins are lovastatin, simvastatin, pravastatin, fluvastatin, pitavastatin, atorvastatin and rosuvastatin. What is the difference between them?


1. The difference in medication time

First, the time of taking medicine is related to the length of half life.

The liver is synthesizing cholesterol for 24 hours. Atorvastatin and rosuvastatin have a longer half-life and are associated with their strong cholesterol-lowering effects and can be taken at any time.

Since cholesterol synthesis peaks between midnight and 2 am, simvastatin, pravastatin, fluvastatin, and pitavastatin have a shorter half-life and should be taken at bedtime.

Second, the time of taking medicine is related to the impact of food.

Food can promote the absorption of lovastatin. If taken on an empty stomach, the absorption of lovastatin is reduced by 30%, and lovastatin should be taken at dinner.


2. The difference in interaction

First, all statins

Statins are delivered to hepatocytes via the organic anion transporter OATP1B1. Cyclosporine has an inhibitory effect on OATP1B1, which increases the blood concentration of statins and has serious interactions.

Second, lovastatin, simvastatin, atorvastatin

Mainly through CYP3A4 metabolism, combined with amiodarone, verapamil, diltiazem, itraconazole, posaconazole, voriconazole, clarithromycin, erythromycin, telithromycin, cyclosporine and other CYP3A4 inhibitors, Should be extra cautious!

Third, fluvastatin

Mainly through CYP2C9 metabolism, should be used with CYP2C9 inhibitors such as fluconazole.

Fourth, pitavastatin, pravastatin, rosuvastatin

Pivavastatin is mainly metabolized by glucosamine, and the metabolism of pravastatin and rosuvastatin is not significant and the interaction is less.


3. The difference in lipid lowering strength

First, there is a large difference in the rate of cholesterol lowering between different types of statins.

Second, when the same statin dose is multiplied, the cholesterol reduction is only increased by 6%.

The FDA cautions that for patients taking simvastatin 40 mg that does not adequately lower LDL-C, another cholesterol-lowering therapy should be chosen.


4. Differences in adverse reactions

First, statins have hepatotoxicity

The hepatotoxicity of statins is mainly manifested by elevated transaminase, with an incidence of about 0.5 to 3%. When the transaminase rises more than 3 times the normal value, the dose should be reduced or discontinued.

Second, statins have myotoxicity

When the patient has muscle discomfort and/or weakness and continuous detection of a progressive increase in creatine kinase, the statin dose should be reduced or discontinued.

It has been reported that when vitamin D is used in patients with vitamin D deficiency, the incidence of statin-induced myalgia is reduced and the tolerance to statins is increased. May be associated with vitamin D deficiency and increased myopathy and insulin resistance.

Third, there are differences in the adverse reactions of statins.

When using a statin for an adverse reaction, try another statin under the guidance of a doctor.

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