Statins (Formulary: Cardiovascular)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Statins are the drugs of first choice for lipid lowering. 

  • All currently available statins have long-term evidence of safety. 
  • See Lipid lowering guidance (link below) for ercommendations on which statin, which dose, what and when to monitor, and how to manage side effects. 
  • Interactions: Statins can interact with many drugs and it is important to check for interactions before prescribing. See: BNF.
  • Muscle effects: Rhabdomyolysis associated with lipid-regulating drugs such as the fibrates and statins appears to be rare (approximately 1 case in every 100 000 treatment years) but may be increased in those with renal impairment and untreated hypothyroidism. Concomitant treatment with drugs that increase plasma-statin concentration increases the risk of muscle toxicity; concomitant treatment with a fibrate and a statin may also be associated with an increased risk of muscle toxicity. Advised to caution patients to stop statin or fibrate, and seek medical advice if develop new acute muscle symptoms.
  • Swallowing difficulties and NG administration: Rosuvastatin capsules are licensed to be opened and the contents administered. In NHS Highland rosuvastatin capsules, are non-formulary except for those patients who have swallowing difficulties, where other statin therapy has not been tolerated, or who require NG tube administration. 

Guidance

MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).
MHRA advice: Statins: risk of hyperglycaemia and diabetes (December 2014) (www.gov.uk)

ATORVASTATIN - (First line)

Therapy notes

MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk)

Formulation and dosage details

Formulation:

Tablets 10mg, 20mg, 40mg, 80mg

ROSUVASTATIN - (Second line)

Therapy notes

MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets 5mg, 10mg, 20mg

Tablets 40mg (specialist initiation only)

Formulation and dosage details

Formulation:

Capsules 5mg, 10mg, 20mg (non-formulary)

Dosage:

In NHS Highland rosuvastatin capsules, are non-formulary except for those patients who have swallowing difficulties, where other statin therapy has not been tolerated, or who require NG tube administration. 

Rosuvastatin capsules are licensed to be opened and the contents administered:

  • In swallowing difficulties the capsule can be opened and the contents sprinkled on soft food, for details see EMC.
  • The capsules are also licensed for NG administration, for details see EMC.

PRAVASTATIN

Therapy notes

Included in NHS Highland formulary as mentioned in National cardiovascular disease (CVD) prevention and risk factors toolkit (Lipid pathway | Right Decisions).

Formulation and dosage details

Formulation:

Tablets 10mg, 20mg, 40mg

Dosage:

To be considered if patient is intolerant of atorvastatin and rosuvastatin. 

SIMVASTATIN

Therapy notes


  • MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets 10mgOTC 

Tablets 20mg, 40mg

Dosage:

For existing patients only. NOT for new patients

  • NOT recommended to be started as NOT high intensity statin and higher incidence of side effects than other statins.

Editorial Information

Version: 2

Document Id: F053