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DYSLIPIDEMIA

Effectiveness and Tolerability of Every-Other-Day Rosuvastatin Dosing in Patients with Prior Statin Intolerance

Clinical Associate Professor, Department of Pharmacy Practice, Schools of Pharmacy and Medicine, University of Kansas; Assistant Director, Lipid, Atherosclerosis, Metabolic and LDL-Apheresis Center, University of Kansas Medical Center, Kansas City, KS

Carmelo V Venero, MD

Preventive Cardiology Fellow, Hartford Hospital, Hartford, CT

Cheryl A Gibson, PhD

Research Associate Professor, Department of Internal Medicine, University of Kansas Medical Center

Janelle F Ruisinger, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice, Schools of Pharmacy and Medicine, University of Kansas

Patricia A Howard, PharmD FCCP BCPS

Professor and Vice-Chair, Department of Pharmacy Practice, School of Pharmacy, University of Kansas

Paul D Thompson, MD

Director of Cardiology—The Henry Low Heart Center, Hartford Hospital, Hartford, CT; Professor of Medicine, University of Connecticut, Farmington, CT

Patrick M Moriarty, MD

Associate Professor, Department of Internal Medicine; Director, Lipid, Atherosclerosis, Metabolic and LDL-Apheresis Center, University of Kansas Medical Center

Reprints: Dr. Backes, Department of Pharmacy Practice, Lipid, Atherosclerosis, Metabolic and LDL-Apheresis Center, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, fax 913/588-2355, jbackes{at}kumc.edu

BACKGROUND: Statins are generally well tolerated, but some patients discontinue therapy secondary to adverse effects. Dosing a statin (rosuvastatin) every other day (EOD) may provide significant lipoprotein changes while avoiding common adverse effects in this statin-intolerant population.

OBJECTIVE: To determine the effect and tolerance of EOD rosuvastatin in patients previously intolerant to statin therapy.

METHODS: We performed a retrospective analysis of patients treated with EOD rosuvastatin at 2 lipid specialty clinics: the University of Kansas Lipid, Atherosclerosis, and LDL-Apheresis Center and the Hartford Hospital Cholesterol Management Center. Approximately 2600 charts were reviewed to identify patients receiving rosuvastatin EOD who previously had experienced statin intolerance. Fifty-one patients were eligible for the analysis, which evaluated changes in the lipid profile, the number achieving their low-density lipoprotein cholesterol (LDL-C) goals, and the percent tolerating rosuvastatin EOD. Laboratory data were assessed immediately prior to rosuvastatin EOD therapy and at the first follow-up.

RESULTS: Myalgias (76.5%) and increased transaminase levels (19.5%) were the most common causes of prior statin intolerance, but 72.5% (37/51) of patients were able to tolerate the EOD therapy (mean dose 5.6 mg) regimen for 4 ± 2.9 (mean ± SD) months. Mean LDL-C decreased 34.5% (p < 0.001) in the patients who tolerated the regimen, enabling approximately 50% to achieve their LDL-C goal. All patients who were considered to be intolerant to rosuvastatin EOD therapy (27.5%; 14/51) reexperienced the symptoms of their prior statin intolerance.

CONCLUSIONS: Treating patients intolerant to statins with rosuvastatin EOD was tolerated by the majority of patients and reduced LDL-C in our study. This dosing strategy may be useful in patients intolerant to once-daily statin dosing, although such an approach has not been documented to reduce cardiovascular events.

Key Words: dosing, myalgia, rosuvastatin, statin

Published Online, February 19, 2008. www.theannals.com, DOI 10.1345/aph.1K604