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Alternate-Day Statin Therapy

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Alternate-Day Statin Therapy

Alternate-day statin therapy is used to reduce low density lipoprotein cholesterol (LDL-C) levels in patients with hyperlipidemia. These drugs, which act as hydroxymethylglutaryl-coA (HMG-CoA reductase inhibitors, cause an improvement in LDL-C concentrations which could potentially lower the risk for cardiovascular disease and other vascular issues.

Many patients, however, cannot take a daily dose of statins due to adverse effects such as muscle aches or other drug-limiting side effects. Alternate-day statin regimens have been found to be just as effective at reducing LDL-C as daily-dose statins while improving tolerability and decreasing cost of treatment.

To determine the effectiveness of alternate-day statin dosing for lipid reduction, we conducted a systematic review of the literature. This review included 17 trials evaluating alternate day dosing of statins and evaluated their results based on efficacy, safety and economics.

Studies were identified through PubMed, EMBASE, Google Scholar and International Pharmaceutical Abstracts databases. All English language articles were reviewed for inclusion.

On a 4-week basis, several alternate-day dosing regimens were tested, such as alternate days of atorvastatin, rosuvastatin or simvastatin. These dosages were kept up until myalgia and other drug-limiting side effects resolved for each patient.

Atorvastatin, an HMG-CoA receptor inhibitor, is often prescribed to treat hyperlipidemia and ischemic heart disease. While this medication works effectively at reducing total cholesterol and LDL-C levels, it may lead to side effects like myalgia or gastrointestinal complaints. Therefore, alternate-day dosing of atorvastatin has been explored as a possible solution to minimize these side effects while increasing LDL-C lowering efficacy.

The alternate-day dosing regimen is cost-effective and cuts a patient’s cost of taking statins in half. Furthermore, it has the potential to improve adherence and boost lipid lowering capacity in many individuals.

Our pilot study among women with a history of daily-dose statin intolerance revealed that an NP guided alternate dosing protocol was successful in decreasing total and LDL-C levels, increasing its lipid lowering efficacy. A larger prospective and placebo controlled trial is necessary to evaluate whether this NP alternate dosing protocol can influence long-term statin adherence among this population of statin intolerant women.

Unfortunately, the study was limited by the number of subjects enrolled and cannot conclusively prove whether an alternate-day statin dosing regimen can truly impact cardiovascular outcomes through lipid lowering. Furthermore, since these data were observational rather than prospectively obtained and without placebo controls or blinding, they cannot prove whether NP alternate dosing statin protocol is beneficial or should even be considered before classifying a patient as statin intolerant.

Atorvastatin is one of the most commonly prescribed statins for lipid reduction and it’s well-tolerated and cost-effective. Unfortunately, many patients fail to adhere to their treatment with statins despite their potential benefits. Many patients experience myalgia and gastrointestinal distress while on daily statins, which can be difficult to diagnose. This issue is particularly prevalent with the relatively new statins rosuvastatin and simvastatin, which are frequently prescribed at higher dosages. In this pilot study, we evaluated an alternate dosing statin regimen with these statins to see if it was as successful as daily dosing for reducing lipids in patients who had previously experienced statin-induced myalgia and gastrointestinal complaints.

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