Statins 💊
Reference guide for statin medications (Lipitor, Crestor, Zocor, Lipostat, Lescol). Drug table by intensity, common adult doses, and Irish SmPC links.
💡 Overview
- Statins (HMG-CoA reductase inhibitors) lower LDL-C and reduce cardiovascular events.
- Intensity (high / moderate / low) is based on expected % LDL-C reduction — useful for ACS secondary prevention vs primary prevention.
- Prefer high-intensity after ACS (e.g. atorvastatin 80 mg) unless contraindicated or not tolerated.
📋 Ward considerations
- Check LFTs at baseline; do not start if unexplained transaminitis. Recheck if clinically indicated.
- Ask about myalgia; check CK if significant muscle symptoms. Hold statin and seek advice if CK markedly elevated or rhabdomyolysis suspected.
- Review interacting drugs (especially simvastatin/atorvastatin with CYP3A4 inhibitors: clarithromycin, erythromycin, azoles, some HIV/HCV antivirals).
- Hold or dose-adjust in acute severe illness, decompensated liver disease, or pregnancy/breastfeeding (contraindicated).
Statins
Intensity bands & common adult doses
| Drug | Dose | Frequency | Intensity | Notes |
|---|---|---|---|---|
| High-intensity (≥50% LDL-C reduction) | ||||
| Atorvastatin (Lipitor) | 40–80 mg | OD | High | Usual post-ACS choice. Check interactions (e.g. clarithromycin, azoles). |
| Rosuvastatin (Crestor) | 20–40 mg | OD | High | Start 5 mg in Asian ancestry, elderly, or renal impairment before titrating. |
| Moderate-intensity (~30–50% LDL-C reduction) | ||||
| Atorvastatin (Lipitor) | 10–20 mg | OD | Moderate | Common primary-prevention dose; titrate to target. |
| Rosuvastatin (Crestor) | 5–10 mg | OD | Moderate | Often preferred if atorvastatin not tolerated. |
| Simvastatin (Zocor) | 20–40 mg | Nocte | Moderate | Avoid 80 mg (myopathy). Many CYP3A4 interactions — check SmPC. |
| Pravastatin (Lipostat) | 40 mg (max 80 mg) | Nocte | Moderate | Fewer CYP interactions; useful with interacting drugs. |
| Fluvastatin XL (Lescol XL) | 80 mg | OD | Moderate | Less commonly used; check local formulary. |
| Low-intensity (<30% LDL-C reduction) | ||||
| Simvastatin (Zocor) | 10 mg | Nocte | Low | Rarely first-line; may see on long-term charts. |
| Pravastatin (Lipostat) | 10–20 mg | Nocte | Low | Consider if higher intensity not tolerated. |
| Fluvastatin (Lescol) | 20–40 mg | OD | Low | IR capsules; XL 80 mg is moderate intensity. |
High-intensity (≥50% LDL-C reduction)
Atorvastatin (Lipitor)
HighDose:40–80 mg
Frequency:OD
Notes: Usual post-ACS choice. Check interactions (e.g. clarithromycin, azoles).
Rosuvastatin (Crestor)
HighDose:20–40 mg
Frequency:OD
Notes: Start 5 mg in Asian ancestry, elderly, or renal impairment before titrating.
Moderate-intensity (~30–50% LDL-C reduction)
Atorvastatin (Lipitor)
ModerateDose:10–20 mg
Frequency:OD
Notes: Common primary-prevention dose; titrate to target.
Rosuvastatin (Crestor)
ModerateDose:5–10 mg
Frequency:OD
Notes: Often preferred if atorvastatin not tolerated.
Simvastatin (Zocor)
ModerateDose:20–40 mg
Frequency:Nocte
Notes: Avoid 80 mg (myopathy). Many CYP3A4 interactions — check SmPC.
Pravastatin (Lipostat)
ModerateDose:40 mg (max 80 mg)
Frequency:Nocte
Notes: Fewer CYP interactions; useful with interacting drugs.
Fluvastatin XL (Lescol XL)
ModerateDose:80 mg
Frequency:OD
Notes: Less commonly used; check local formulary.
Low-intensity (<30% LDL-C reduction)
Simvastatin (Zocor)
LowDose:10 mg
Frequency:Nocte
Notes: Rarely first-line; may see on long-term charts.
Pravastatin (Lipostat)
LowDose:10–20 mg
Frequency:Nocte
Notes: Consider if higher intensity not tolerated.
Fluvastatin (Lescol)
LowDose:20–40 mg
Frequency:OD
Notes: IR capsules; XL 80 mg is moderate intensity.
Educational reference only. Medical disclaimer