STATIN DOSING





Acronyms


Atorvastatin
Lipitor®, Atorvaliq®

Dosage forms

Tablet
  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg
Suspension (Atorvaliq®)
  • 20 mg/5 ml
  • Comes in 150 ml bottle
  • Store at room temp

Dosing

High cholesterol (adults)
  • Starting: 10 - 20 mg once daily
  • Maintenance: 10 - 80 mg once daily
  • Max: 80 mg once daily
  • Patients who require LDL reductions ≥ 45% may start with 40 mg once daily
  • Assess lipids as early as 4 weeks after initiation and adjust dose as necessary
  • Tablets may be taken without regard to food. Atorvaliq should be taken on an empty stomach (1 hour before or 2 hours after a meal).
Heterozygous familial hypercholesterolemia (10 - 17 years old)
  • Starting: 10 mg once daily
  • Maintenance: 10 - 20 mg once daily
  • Tablets may be taken without regard to food. Atorvaliq should be taken on an empty stomach (1 hour before or 2 hours after a meal).
Homozygous familial hypercholesterolemia (10 - 17 years old)
  • Starting: 10 - 20 mg once daily
  • Maintenance: 10 - 80 mg once daily
  • Max: 80 mg once daily
  • Assess lipids as early as 4 weeks after initiation and adjust dose as necessary
  • Tablets may be taken without regard to food. Atorvaliq should be taken on an empty stomach (1 hour before or 2 hours after a meal).
Kidney disease
  • No dose adjustment necessary
Liver disease

Studies

Generic / Price

  • Tablets: YES/$
  • Suspension (150 ml): NO/$$$$

Fluvastatin
Lescol®, Lescol XL®

Dosage forms

Capsule (Lescol®)
  • 20 mg
  • 40 mg
Tablet, extended-release (Lescol XL®)
  • 80 mg

Dosing

High cholesterol (adults)
  • Lescol
    • Starting: 40 mg once daily in evening
    • Maintenance: 20 - 80 mg/day
    • Max: 80 mg/day
    • For 80 mg/day dosing, give 40 mg twice a day
    • For patients requiring LDL reduction of < 25%, a 20 mg starting dose may be used
    • Do not open capsules
    • May take without regard to food
  • Lescol XL
    • Dosing: 80 mg once daily
    • Max: 80 mg once daily
    • May take without regard to food
    • Do not crush, cut, or chew tablet
Heterozygous familial hypercholesterolemia (pediatric patients 10 - 16 years old)
  • Starting: 20 mg once daily in evening
  • Maintenance: 20 - 80 mg/day
  • Max: 80 mg/day
  • For 80 mg dosing, give 40 mg capsule twice a day or one Lescol XL 80 mg tablet once daily
  • Do not open capsules
  • May take without regard to food
Kidney disease
  • CrCl ≥ 30 ml/min: no dose adjustment necessary
  • CrCl < 30 ml/min: has not been studied at doses greater than 40 mg; use caution
Liver disease

Generic / Price

  • Lescol capsule - YES/$-$$
  • Lescol XL tablet - YES/$$

Lovastatin
Mevacor®, Altoprev®

Dosage forms

Tablet (Mevacor®)
  • 10 mg
  • 20 mg
  • 40 mg
Tablet, extended-release (Altoprev®)
  • 20 mg
  • 40 mg
  • 60 mg

Dosing

High cholesterol (adults)
  • Mevacor
    • Starting: 20 mg once daily with evening meal
    • Maintenance: 10 - 80 mg/day
    • Max: 80 mg/day
    • May be given once daily or in two divided doses
    • Take with meals
  • Altoprev
    • Dosing: 20 - 60 mg once daily at bedtime
    • Elderly: starting dose should be 20 mg
    • Max: 60 mg once daily
    • Take on an empty stomach. Food decreases absorption.
    • Do not crush, cut, or chew tablet
Heterozygous Familial Hypercholesterolemia (pediatric patients 10 - 17 years old)
  • Dosing: 10 - 40 mg/day
  • Max: 40 mg/day
  • For reductions in LDL of ≥ 20%, starting dose should be 20 mg/day. A starting dose of 10 mg/day may be considered for patients requiring smaller reductions.
  • May be given once daily or in two divided doses
  • Take with meals
Kidney disease
  • CrCl ≥ 30 ml/min: no dose adjustment necessary
  • CrCl < 30 ml/min: dosage increases above 20 mg /day should be carefully considered and, if deemed necessary, implemented cautiously
Liver disease

Generic / Price

  • Tablet (Mevacor®): YES/$
  • Tablet, extended-release (Altoprev®): NO/$$$$

Pitavastatin
Livalo®, Zypitamag®

Dosage forms

Tablet (Livalo®)
  • 1 mg
  • 2 mg
  • 4 mg
Tablet (Zypitamag®)
  • 2 mg
  • 4 mg

Dosing

High cholesterol in adults (Livalo and Zypitamag)
  • Starting: 2 mg once daily
  • Maintenance: 1 - 4 mg once daily
  • Max: 4 mg once daily
  • May take without regard to food
Heterozygous familial hypercholesterolemia in pediatric patients ≥ 8 years old (Livalo)
  • Starting: 2 mg once daily
  • Maintenance: 1 - 4 mg once daily
  • Max: 4 mg once daily
  • May take without regard to food
Kidney disease (adults)
  • CrCl < 60 ml/min: recommended starting dose is 1 mg once daily; do not exceed 2 mg/day
Liver disease

Generic / Price

  • Livalo - YES/$-$$
  • Zypitamag - NO/$$$$

Pravastatin
Pravachol®

Dosage forms

Tablet
  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg

Dosing

High cholesterol (adults)
  • Starting: 40 mg once daily
  • Maintenance: 40 - 80 mg once daily
  • Max: 80 mg once daily
  • May take without regard to food
High cholesterol (adolescents 14 - 18 years)
  • Dosing: 40 mg once daily
  • Doses higher than 40 mg have not been studied in this population
  • May take without regard to food
High cholesterol (children 8 - 13 years)
  • Dosing: 20 mg once daily
  • Doses higher than 20 mg have not been studied in this population
  • May take without regard to food
Kidney disease
  • CrCl < 30 ml/min: starting dose of 10 mg is recommended
Liver disease

Generic / Price

  • YES/$

Rosuvastatin
Crestor®, Ezallor™ Sprinkle

Dosage forms

Tablet (Crestor®)
  • 5 mg
  • 10 mg
  • 20 mg
  • 40 mg
Capsule (Ezallor™ Sprinkle)
  • 5 mg
  • 10 mg
  • 20 mg
  • 40 mg

Dosing

High cholesterol (adults)
  • Starting: 10 - 20 mg once daily
  • Maintenance: 5 - 40 mg once daily
  • Max: 40 mg once daily
  • Asian patients: use a starting dose of 5 mg/day. Use caution if exceeding 20 mg/day. See statins in Asian patients for more.
  • In patients with homozygous familial hypercholesterolemia, starting dose of 20 mg is recommended
  • May take without regard to food
Heterozygous familial hypercholesterolemia (pediatric)
  • 8 - 9 years: 5 - 10 mg once daily
  • 10 - 17 years: 5 - 20 mg once daily
  • May take without regard to food
Homozygous familial hypercholesterolemia (pediatric)
  • 7 - 17 years: 20 mg once daily
  • May take without regard to food
Kidney disease
  • CrCl < 30 ml/min: recommended starting dose is 5 mg once daily. Do not exceed 10 mg/day.
Liver disease

Generic / Price

  • Tablet - YES/$
  • Capsule - NO/$$

Other

Ezallor™ Sprinkle
  • Capsules should be swallowed whole. Do not crush or chew.
  • Capsules may be opened and granules sprinkled on a teaspoon of soft food such as applesauce or chocolate/vanilla flavored pudding. Swallow whole without chewing within 60 minutes of combining.
  • May be given via NG tube. See Ezallor PI for instructions.

Simvastatin
Zocor®, Flolipid®

Dosage forms

Tablet (Zocor®)
  • 5 mg
  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg
Suspension (Flolipid®)
  • 20 mg/5 ml
  • 40 mg/5 ml
  • Comes in 150 ml bottle
  • Store at room temperature
  • Use within 30 days of opening

Dosing

High cholesterol (adults)
  • Starting: 10 - 20 mg once daily in the evening
  • Maintenance: 5 - 40 mg once daily
  • Max: 40 mg once daily
  • Asian patients: simvastatin may increase risk of myopathy. See statins in Asian patients for more.
  • 80 mg dose should be limited to patients who have been taking it for ≥ 12 months without muscle toxicity
  • The tablet may be taken without regard to food. The suspension should be taken in the evening on an empty stomach.
Heterozygous familial hypercholesterolemia (pediatric patients 10 - 17 years old)
  • Starting: 10 mg once daily in the evening
  • Maintenance: 10 - 40 mg once daily
  • Max: 40 mg once daily
  • The tablet may be taken without regard to food. The suspension should be taken in the evening on an empty stomach.
Kidney disease
  • CrCl < 30 ml/min: recommended starting dose is 5 mg once daily
Liver disease

Generic / Price

  • Zocor - YES/$
  • Flolipid - NO/$$$$

Efficacy

COVID-19

Roszet®
Rosuvastatin + ezetimibe

Dosage forms

Tablet
  • Rosuvastatin - Ezetimibe
    • 5 mg - 10 mg
    • 10 mg - 10 mg
    • 20 mg - 10 mg
    • 40 mg - 10 mg

Dosing

High cholesterol
  • Dosing: 5/10 mg - 40/10 mg once daily
  • Asian patients: starting dose should be 5/10 mg once daily. Consider risks/benefits of doses > 20/10 mg. Exposure to rosuvastatin is higher in Asian patients (see statins in Asian patients for more).
  • Kidney disease:
    • CrCl ≥ 30 ml/min: no dose adjustment necessary
    • CrCl < 30 ml/min: recommended starting dose is 5/10 mg once daily. Do not exceed 10/10 mg once daily.
  • May take without regard to food
  • Do not crush, dissolve, or chew tablets

Generic / Price

  • NO/$$$$

Vytorin®
Simvastatin + ezetimibe

Dosage forms

Tablet
  • Ezetimibe - Simvastatin
    • 10 mg - 10 mg
    • 10 mg - 20 mg
    • 10 mg - 40 mg
    • 10 mg - 80 mg

Dosing

High cholesterol
  • Starting: 10/10 - 10/20 mg once daily in the evening
  • Maintenance: 10/10 - 10/40 mg once daily in the evening
  • Max: 10/40 mg once daily
  • May take without regard to food
  • For patients requiring > 55% LDL reduction, recommended starting dose is 10/40 mg/day
  • Due to increased risk of myopathy, the 10/80 mg dose should be restricted to patients who have been taking 10/80 mg chronically (> 12 months) without evidence of muscle toxicity

Generic / Price

  • YES/$-$$

Caduet®
Amlodipine + atorvastatin

Dosage forms

Tablet
  • Amlodipine - Atorvastatin
  • 2.5 mg - 10 mg
  • 2.5 mg - 20 mg
  • 2.5 mg - 40 mg
  • 5 mg - 10 mg
  • 5 mg - 20 mg
  • 5 mg - 40 mg
  • 5 mg - 80 mg
  • 10 mg - 10 mg
  • 10 mg - 20 mg
  • 10 mg - 40 mg
  • 10 mg - 80 mg

Dosing

Hypertension / Hyperlipidemia
  • Starting: 2.5/10 mg once daily
  • Maintenance: 2.5/10 - 10/80 mg once daily
  • Max: 10/80 mg once daily
  • May take without regard to food

Generic / Price

  • YES/$$




STATIN INTENSITY CHART

  • Reference [10]
High-intensity statin therapy
(lowers LDL by ≥ 50%)		 Moderate-intensity statin therapy
(lowers LDL by 30 - 49%)		 Low-intensity statin therapy
(lowers LDL by < 30%)
  • Atorvastatin (Lipitor®) 40 - 80 mg/day
  • Rosuvastatin (Crestor®) 20 - 40 mg/day
  • Atorvastatin (Lipitor®) 10 - 20 mg/day
  • Rosuvastatin (Crestor®) 5 - 10 mg/day
  • Simvastatin (Zocor®) 20 - 40 mg/day
  • Pravastatin (Pravachol®) 40 - 80 mg/day
  • Lovastatin (Mevacor®) 40 - 80 mg/day
  • Fluvastatin XL (Lescol XL®) 80 mg/day
  • Fluvastatin (Lescol®) 40 mg twice daily
  • Pitavastatin (Livalo®) 1 - 4 mg/day
  • Simvastatin (Zocor®) 10 mg/day
  • Pravastatin (Pravachol®) 10 - 20 mg/day
  • Lovastatin (Mevacor®) 20 mg/day
  • Fluvastatin (Lescol®) 20 - 40 mg/day

PRICE ($) INFO

  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • Pricing based on one month of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability

BIBLIOGRAPHY