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Wednesday, April 23, 2014
Pharmacy and Medications
Switch from Lipitor to Lovastatin?
Because of the difference in cost, our health plan suggested switching medications from Lipitor (10 mg) to Lovastatin (40 mg). These are the prescribed amounts given by the doctor. Why the variation in amount? Does that mean the lovastatin is not effective at a lower dose?
Lipitor (or atorvastatin) and lovastatin are both cholesterol-lowering medications that belong to a class called Hmg-CoA reductase inhibitors. Hmg-CoA reductase is an enzyme that is involved in the production of cholesterol in the liver. By blocking this enzyme, the amount of cholesterol produced in the body is decreased.
There are new guidelines that recommend the "ideal" cholesterol levels for people with different risk factors for heart problems. For patients with a very high risk of developing coronary heart disease, the National Cholesterol Education Program recommends lowering a person's LDL cholesterol below 70 mg/dL. For those at moderate risk of developing coronary heart disease, the recommended LDL cholesterol level is below 100 mg/dL. Medications such as atorvastatin and lovastatin and other Hmg-CoA reductase inhibitors vary in their ability to lower LDL cholesterol. Atorvastatin can lower LDL cholesterol between 35 and 60%, depending on the dose used. Lovastatin can lower LDL cholesterol between 25 and 48%, depending on the dose used.
10 mg of atorvastatin causes about a 35% decrease in LDL cholesterol, whereas 10 mg of lovastatin only causes about a 25% decrease in LDL cholesterol. 40 mg of lovastatin causes between 35-40% decrease in LDL cholesterol. This means that a 10mg of atorvastatin is appproximately equivalent to the 40 mg dose of lovastatin. This does not mean that lovastatin is not effective at a lower dose, it just means that it is not as effective as the lower dose of atorvastatin.
The switch your insurance proposes may be appropriate if your goal for cholesterol reduction is no more than 40%. Barring special pricing, doses of lovastatin greater than 40mg daily are considerably more expensive than similarly effective doses of atorvastin. Atorvastatin inherently produces a greater reduction in cholesterol at its maximal daily recommended dose than lovastatin. If your goal cholesterol is greater than 40%, it is likely that atovastin is both less expensive and more effective. of lovastatin
Your physician determines the correct drug and dose for you based on how much he/she thinks your cholesterol needs to be lowered. The MD will monitor your levels and adjust your medications as necessary based on any other risk factors for coronary heart disease that you may have. It is important that you talk with your physician about any other concerns you may have with this medication switch.
Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati