Any Advantages Or Is Livalo Just One More Statin?

When I heard that Livalo was being promoted as the newest statin to market I first wondered why anyone would bother to bring a newer drug to a field of excellent drugs many of which have been around long enough to be available as inexpensive generics.  The primary sales pitch of the Kowa-Lilly reps seems to be that this is “mg. for mg. the most potent statin” available.  By this they mean that per mg. of dosing it lowers LDL cholesterol more than any other statin.  Anyone who understands pharmacology at all immediately recognizes this as meaningless statement.  Every drug has its appropriate dose, and comparing the number of milligrams of one drug to the number of mg. of another drug is just silly.  In essentially every class of drugs each medication has its own appropriate dose and comparing the dose in mg of one drug to another, and saying that the drug with the lower mg dose is more potent is just ridiculous.

Livalo has a number of things going against it and at this point I cannot think of a single reason I would prescribe it unless someone can show it to have unique benefits as compared to more established statins.  Here are my concerns and reasoning:

  • No Better at Lowering LDL: Livalo is promoted by its manufacturer to be equally effective at lowering LDL cholesterol at its medium and highest doses to atorvastatin (Lipitor) and Simvastatin (Zocor).  Average LDL reductions as follows:
    • Livalo 2 mg = 38 – 39% reduction
    • Atorvastatin 10 mg = 38% reduction
    • Simvastatin 20 mg = 35% reduction
    • Livalo 4 mg = 44-45% reduction
    • Atorvastatin 20 mg = 44% reduction
    • Simvastatin 40 mg = 43% reduction
    • Atovastatin 40 and 80 mg dosing not compared to Livalo.
  • No Data for Cardiovascular Outcomes:  Livalo has no data for primary efficacy at reducing cardiovascular morbidity or mortality.  This type of data is well established for simvastatin and atorvastatin.  This is a big deal.  Why use a drug with no reason to expect superior efficacy that lacks data to even be confident it has any efficacy at the real desired outcome.
  •  High Price for Many Years:  Livalo has just been released to market.  It is priced at at 115.99/ 30 tablets.  This compares to simvastatin 20  at $5.90/ 30 tablets  at Costco (no Livalo price online at Costco, likely because there is so little market demand).  Generic Lipitor (atorvastatin) will become available as a generic late this year, and is currently available at Costco at $165.70/ 30 tablets.  All told the generic statins are appropriate for the vast majority of patients.
  • Safety Data Pending:  Why use a drug with no apparent advantages immediately after it comes to market.  All of us remember the fiascos of many newly released drugs when they became available to the mass market and serious problems came to light.  (Think Ketek and Vioxx)

Livalo seems to have a side effects profile very similar to the currently available statins.  If there is a lower incidence of myalgias and myositis there may turn out to be a niche role for Livalo, but at this time I’ll wait to see a lot larger experience than the studies presented so far.

Summary on Livalo:  A simply Ho-Hum new drug that I plan to forget the name of as soon as I finish this post.  Stick with either a good generic like simvastatin.  If you need a branded drug use one with more post-market experience and the promise of being available as a generic very soon like Lipitor.  Overall the Simvastatin vs Lipitor debate leans towards simvastatin until Lipitor becomes generic.  Then I anticipate atorvastatin to be the stain of choice for most patients.  For the patient who has mild to moderate myalgias on either of these two drugs, consider a very low dose of pravastatin or even red yeast rice.

50 Responses to Any Advantages Or Is Livalo Just One More Statin?

  1. Ive been a marathon runner and did 10 full ones from ages 59 1/2 to 69 1/2.
    I have Lyme disease and heart failure and afib. My cholesterol has been fine since I’ve been a VEGAN in 1999. My cholestrol levels are LOW as well as triglicerides. I’ve put myself on Red Yeast Rice rather than succuming to statins which my cardiologist keeps wanting me to try. I am currently running 3-4 miles a day and never felt better. My cardiologist says I should take Livalo wit red yeast rice even though my pharm says, “NO’ as well as the manufacturer of lIVALO! H

  2. I am a retired Physician. I had a CABG X 3 at age 40 in 1987…I have been on Statins and had side effects that were approaching “More than annoying”…Cramps and muscle pain, inability to function normally were taking over my life and making me feel lousy all the time.

    Recently my Cardiologist put me on Livalo. I titered my dosage up from 2mg once a week, to 2mg 3 X a week in combination with Co Q 10 Ubiquinol NOT Ubiquinone. It is more pure apparently and absorbs more readily at 100mg vs 200mg.

    I have had no musculoskeletal side effects whatsoever and I do not feel like a tired old man any more. I have worked out almost every week ..3 times a week ,since my surgery, lifting light to medium free weights and not doing arduous amounts. I use the treadmill for 20 minutes each time. I do planks and eat right. I am 67 years old, I weigh 140 lbs.and 5’9″ and sing with a band now for my fun.

    I can now walk with my wife on the beach or the street…something I use to dread. My legs do not become overwhelmingly tired any more. So far Livalo has done it for me..I tried every other Statin with no relief.My Cardiologist stated that he has the majority of his patients over 60 , complaining of Statin Side effects and I suppose he is trying to shift them over to Livalo. All I can say is that it works for me. As a rule I consider any meds to work for some but not all… I hope I lucked out this time. My labs are WNL except for Tot Cholesterol but that was because the baseline was taken while I was NOT TAKING any statin. I took a “Drug Holiday” and then started the Livalo after the last labs. I will wait a while and retest to see what my numbers are and whether they have changed with Livalo use.

    NOTE: I am a Type IIa Familial seen on Lipoprotein electrophoresis.
    My Triglycerides have always been normal

  3. Sue: the more detailed cholesterol testing, with LDL and HDL particle size are occasionally useful in cases where it is unclear if treatment is needed, but not used in most patients. Your physician can look at your numbers and response to livalo and decide on whether this type of testing is indicated for you. I know of no data saying that statins have more or less side effects in women vs. men. It is unusual that your physician chose an expensive branded statin when good generic options are available as the first choice. Hope you do well. DrP.

  4. Started with livalo about two weeks ago and I am on atenolol for a problem I had while going thru chemo 7 yrs ago for breast cancer. My hdl is around 65 but total is 300. This is the first time I am on a statin and so far no bad signs. I will go for blood test in about 3/4 weeks so will know more if its working. I asked for a cholestral particle test which I heard about on dr oz. I also heard that statins are tougher on women. Dr can u comment on this.

  5. I could not handle any statins and have been on gemfibrozil for a while, but it was not doing the trick until we added livalo. Now my levels have been better managed and I can tolerate the 2mg without any side effects of the statin. Before livalo we were unable to get my numbers to normal (my dctor and I)

  6. I’ll jump into the fray here. I am a fit 55 year old female with a total cholesterol of 283. I’m all comfy in my chair so I won’t get up and check what the HDL/LDL breakdown is, but it was not going in the right direction from the past few years when my doctor wanted me to try three months of diet and lifestyle change. I was a rockstar for the first month, then fell off. So, this Fall she told me I needed medication. After two weeks on generic Lipitor I felt as if I had been beaten with a tire iron. Arms, legs, wrists….everything incredibly sore. Also gave me a severe case of the ‘jimmy legs’, I felt as though I just COULD NOT settle my legs in the evening and it was especially bothersome at bedtime. Then I tried Simvistatin (sp?) with the same results. Now, I’m trying Livalo for the first time today. I’ll get back to this site and let you know if I experience the same side effects. I have many friends on the first two drugs I tried and they report no side effects, so I guess it’s just my personal body chemistry that can’t tolerate them. Although….when I mentioned that my legs were restless they paused for thought and said ” Ohhhhhhh, maybe THAT’S why I can’t sit at the dinner table for more than five minutes…”
    I also decided to make an appointment with a dietitian to discuss revamping my diet. I can’t let a pill do all the work, after all.
    Good luck to all of you in your cholesterol lowering journey!

  7. Over the years I have been prescribed every cholesterol-lowering medication out there. With every one I experienced extreme weakness and pain in my legs. My cardiologist put me on Livalo 2 mg. in April. By July my numbers had decreased significantly. I have had no muscle weakness and am tolerating the medication with no side effects.

  8. Since I posted in May (see my post Andrea)My triglycerides are now withing normal limits, my cholesterol is in healthy limits, and Livalo has decreased my LDL’s to very healthy levels. I still take the Welchol, Lovaza, and the Livalo (4mg)now. I am eating a heathy diet as prescribed and exercise as well. The other statins I was on made me feel sick all the time. I am so greatful that Livalo has done its job and I have done mine. Living life again and loving it.

  9. Ben N: Welchol functions by a second mechanism that the statins, and is less potent at lowering LDL cholesterol. They are often used together. DrP.

  10. I was taking welchol and then the doc added pravastatin. I have been having terrible pains in the muscles of my arms with stiffness also. My last total cholestrol was 177 so obviously the cholestrol is lowered. Because of the pains the doc has prescribed livalo and is removing the pravastatin. I don’t understand why I am taking 2 cholestrol medications at the same time or the risks. Any help out there?

  11. Brian –

    My doctor stated to me that Livalo is unique to all other statins through a metabolizing process called glucoronidation. Because of this it is liver friendly and low potential for side effects. I’ve been taking 2mg for over two years now and am doing great. I also take Lovaza, Omeprazole, and a baby aspirin daily.

  12. I have been dx. with severely high triglycerides (873) LDL (199) Cholesterol (363) HDL (53) I have been on Lavaza for several weeks now and my triglycerides have dropped tremendously, but LDL, HDL, Chol severely out of whack. I have tried the marketed statins with severe side effects, muscle/bone pain severe fatigue etc. I took my first dose of Livalo yesterday. I am excited by the comments that this drug has low incident of side effects and its efficacy in correcting lipid and cholesterol levels are good. Prying for good results!

  13. Brian C: I’m no expert on apolipoprotenin genotype testing, but I believe you are saying you have one gene for apolipiprotein E type 3 and another gene for type 4. I believe type 3 is normal, type 4 puts you at higher risk for atherosclerosis. I am not aware that a heterozygous state of having one normal and one higher risk gene puts the person with this genotype at a higher risk. Whether to take a statin for a modestly elevated LDL and a modestly low HDL depends on other risk factors and is a personalized decision between a patient and their physician. I don’t think that in most patients Livalo has plaque stabilizing properties above and beyond other statins. If someone knows of this data please let me know. Thanks. DrP.

  14. I am 55 years old, 5’9″ amd 170 LBS, am 13% body fat and athletic. I have a family history of heart disease. My total cholesterol is 208, with an LDL of 143 and an HDL of 43 (these numbers have been pretty much the same for 20 years). I have an ApoE genotype of 3/4 which my doctor tells me means that my HDL does not do a good job clearing my LDL. My doctor wants me to take Livalo and I am against it – he says it is the best statin as it works to prevent any built up plaque on the arterial walls form breaking off and causing a clot and heart attack (which is what killed Tim Russert). Does anyone have any alternatives they can suggest- I do not want to risk the side efects (severe muscle aches and cramps) that can occur with Livalo, not to mention the liver damage it can cause_ I welcome any comments or suggestions? Am I being overly concerend here?

  15. Re: Mary – It sounds like Mary might have a lot of other reason for her post.

    I have been taking Livalo for 6 months. I started with an LDL of 168 and in 3 months, my LDL was 93. I have had no problems to date and my doctor is pleased with my numbers. I have a bad family history of CVD, MI’s, etc. and my LDL was the only number out of whack, but diet and exercise would not budge the number. Livalo is doing the job. And it is a very low dose, which I like.

  16. I just started Livalo three weeks ago. When I started I already had significant knee pain due to arthritis. However, three weeks in, the knee pain is much worse and now my lower legs are aching. I have tried Lipitor and Pravachol and had the same result. I am at my wit’s end as I have to get my cholesterol down. In my 50s with high incidence of heart disease in my family.

  17. I have tried, Crestor, Lipitor and Simvastatin and have experienced terrible muscle pain for weeks after. I had to stop them all. It is amazing to me that the medical professionals still continue to prescribe then dismiss and downplay the side effects. These side effects are horrible.

    I agree we do not need one more statin. I might willing to try this last drug because for me it has become a quality of life issue, not only lowering my LDL. Low LDL with pain killers and bed rest or a normal healthy life without pain. Has anyone other than Mary experienced terrible side effects from Livalo?

  18. D’Layne: Niaspan is not especially good for lowering LDL, but is one of the best drugs to raise HDL. For LDL lowering very high doses like 1500+ mg daily are usually needed. DrP.

  19. Dr. Pullen, What’s your opinion re: Niaspan if one can’t take any statins? I’ve tried all except Livalo at various dosages & get to where I can hardly walk, sit or stand. I’ve been on Niaspan just a month now so have no results yet; am hopeful my LDL will go down.

  20. Wouldn’t you agree that all statins have the class effect on plaque regression and inflammation? BTW Livalo does have plaque regression studies from its long history in Japan.

    Wouldn’t the metabolism of Livalo which limits drug drug interactions be a strong enough reason to put patients first line on it? Wouldn’t you want your patients to have the lowest risk of possible drug interaction because Livalo is metabolized differently.

    I think your comments should be revised on Livalo as there are plenty of reasons why a patient should be on Livalo.

    What if they are on HIV protease inhibitors? what if they like drinking grapefruit juice?

    It is clear that Livalo has established itself as noninferior to atorvastatin in terms of efficacy, so what sets it apart is its’ metabolism which will ensure patient safety.

  21. Statin cardiovascular benefit is more likely related to lowering of inflammatory damage to vascular endothelium than ldl lowering. If I recall correctly, recent studies comparing a statin and statin with niacin or tricor showed no additional reduction in cardiac mortality or events with adding niacin or tricor even with lower ldl #’s.

    I’m not aware that livalo has HS CRP lowering data. I would limit livalo to those for which other generic statins have not helped or for which patients were intolerant. Otherwise there’s no compelling reason to use livalo as first line.

  22. Dr. Pullen –

    Over the last six years I tried Lipitor, Zocor, Crestor, and Pravachol. After two months I could not tolerate Lipitor nor Zocor due to myalgias. I was then put on Crestor which seemed fine for about four months. I then started having abdominal pain and headaches. My doctor finally put me on Pravachol which I tolerated great. However, my numbers were not moving down much at all. When Livalo came to market, he suggested I take that – 2mg. I can tell you after being on Livalo for just over a year now, my numbers are phenomenal. LDL is 92, HDL 54, and Triglycerides 112. The best part is, the tolerability has been fantastic. He told me I can take it anytime of day too, with or without food. I think you should reconsider your comments above. It has been a blessing in my life.

  23. Dr: I call on you to revise your remarks regarding Livalo. First, your comment that there is no data on long term outcomes is a Red Herring. As you well know, it takes over a decade to accumulate outcome data. Livalo is a new drug, the data does not exist yet. What we do know is it is (by your next chart) one of the most effective statins on the market, and reports (a few of which are posted here) are that it has a far lower rate of serious side effects. Are you seriously concerned that it will not have measureable cardiovascualr benefits? Based on what data? The whole science of statins is based on lowering cholesteroal levels. You got something else? I doubt it. Lastly, comments regarding price are another Red Herring; all new drugs cost more. This is how drug companies recoup their development costs. Presumably the public can decide if it is worth the higher cost. In my case, it is. Pick up your Herring, they stink.

  24. Craig: Potency is not determined on a mg of one drug to mg of another drug. The potency is measured by how much effect you can get from the appropriate dose of a given drug. Many classes of drugs have similar situations. 7.5 mg of meloxicam is roughly equivalent to 600 mg of ibuprofen, but not really more potent. DrP. The drug interaction issue may at times be improtant, but is manageable. DrP.

  25. In response to Jay on the topic of price, I was given a co-pay card by my doctor for Livalo that makes the price $25 per month for 12 months. It is even good for cash paying patients, and that is what I chose to do. My insurance has Livalo at tier 3, but I told the pharmacist not to use my insurance and run the prescription as cash and it only costs my $25. I would suggest calling your doctor or going on-line. I’m sure there is a Livalo website and the co-pay information might be there.

    Dr. Pullen – as I have read this thread, your posts and posts by others, to me, it does seem like Livalo has quite a few advantages compared to other statins. It has solid reductions, it is safe and tolerable, it metabolism sets it apart and it is affordable at $25 per month. I am not sure when you first posted this, but it seems like if some of these points are true, you might revise your earlier mis-charaterizations.

  26. I was diagnosed with high cholesterol earlier this year. I was not sure I wanted to take a statin for thee rest of my life. I tried diet and exercise for 3 months and my LDL did not budge. I was still reluctant, but my doctor gave me a book to to read by Dr. Michael Davidson, who from what I’ve learned is a pretty well-respected guy in the lipid community. After reading the book, I told my doctor that I wanted to be on Livalo and it was for one reason…from what I’ve read, Livalo has less potential for drug interactions because of the way it is metabolized. It does not use the major pathways in the liver that the other statins do. I currently do not take any other medications, but in the future, I might. To me, that seems important and a big differentiator between Livalo and all other statins. So, I have been on Livalo 2mg for 3 months and my LDL went from 168 to 93. That is a 44% drop. I am pretty happy with that.

    One side not to all the potency discussion I read on this thread. According to Dr. Davidson’s book, to achieve a 30% reduction in LDL, it takes 1 mg of Livalo compared to 5 mg of Crestor or 40 mg of Simvastatin. To me, that seems to be more potent.

  27. I was on Lipitor for about four years before developing myopathy in my legs and arms. My doctor switched me to three different statins over the next few months. The last one (I can’t remember which) caused myopathy and pain within a couple of days; it took six months to go away. As a result I was off statins for about two years. During my recent physical, my doctor was alarmed by my cholesterol levels, and gave me some Livalo samples telling me it was designed to avoid the side effects I had experienced. With this assurance, I agreed to try, but was quite sceptical and honestly a bit scared. Well, it’s been three months, not the slightest symptom, and my cholesterol is under excellent control. Because of bigotry / politics from the medical community as well demonstrated by Dr Pullens remarks, I have to pay for it out of my own pocket, my insurance company refuses to pay even partially. Sigh. At least I have my cholesterol under control.

  28. After trying Zocor, Lipitor and Crestor (all of which created unbearable pain in my legs and problems with my liver – with Crestor being by far the worst, it took months to recover from a two week course of Cestor) my Dr. gave me Livalo to try.
    I have been taking it for six months now with — so far — no side effects. My overall cholesterol fell by over 100 points within 3 weeks of starting 2mg Livalo once a week. I gradually have increased the dosage to 2mg three times a week and my overall cholesterol has fallen from 340 to 190. My only real problem with this drug is the price (a thirty day supply – my insurance company will not authorize a 60 day supply – is $75 with my insurance and $414 without it).
    So far so good, at least for me. Livalo is a drug that my Dr. thinks is suitable for people that can’t take one of the better established statins. So far I agree.

  29. I was on simvastatin as well as prevastatin in the past and had problems with joint pain and muscle aches. I have serious cholesterol problems with an overall of 260 and an LDL at 188. My dr prescribed livalo and I pick it up later today. Hopefully it works because I went off medicine for a year because I gave up hope that I would find one that does not cause joint pain. I am on a high deductible plan so price is also an issue but luckily I am getting free samples of the livalo for now.

  30. Please come back in a while and let us know how this worked, both re side effects and LDL drop. DrP.

  31. I took Lipitor and that other one mentioned that has been around a while and felt like I was 100 years old and I was in my 40’s!! The leg cramps, the weakness, all of it was just too much for me….I quit taking them and told my doctor why I quit. Needless to say, my numbers are now extremely high…HDL and LDL are not good. I just had my tests done last week and I have a new doctor. I explained why I stopped taking the other meds to him and he has now given me Livalo…4mg cut in half..3 times a week. Just swallowed my first pill….we shall see.

  32. I tried the the generic Zocor with good cholesterol lowering results, but I had high “CK” levels. My doctor had me try the Lipotor ($4/month card) again excellent results lowering my cholesterol. However, my “CK” levels were very high again. We moved to the Livalo (personally I was annoyed because of the $25/month cost). This medicine worked great for both lowering my cholesterol and my “CK” levels were at an acceptable level. I could bike and run with little discomfort! I road and mountain bike thousands of miles/year, so not having those minor aches is beneficial. My non-docotor opinion – each individual is different, work with your doctor to get the best medicine for you. I agreee with Dr. Pullen – stay with the more established drugs, besides the cost/benefit ratio is really great! I am always a bit worried about some new discovery with Livalo. That is how I found this website.

  33. All the other statin drugs made me sick as a dog. I suffered for years before I was smart enough to say ‘to heck with it I want to feel well’. Then I dropped all cholesterol medication. When Livalo came out my doctor convinced me to try it. Wow! Cholesterol dropped from 300 to 200 and triglycerides cut in half. No side effects. So far I’ve been using the discount card to get it for $25 per month. Results so far – I love this stuff. (although my pharmacist says he only has two customers using it -counting me)

  34. Dennis: Certainly there are individuals like yourself who have adverse effects of various statins, as with nearly every other medication, but the statins have excellent research showing significant benefits in various situations. I think your description of them as “terrible drugs” is just way off base. DrP.

  35. I am sorry, but the two drugs you mentioned I have taken both of them and i will tell you, they are absolutely terrible drugs, I have still not gotten over the side effects of these drugs, I took myself off of them after they did a number on me and my wife. I would never prescribe these drugs and tell folks that they are safe, I do not believe they are safe for anyone and taking red yeast rise takes a toll on one as well. lets tell the folks what to expect if they go on the terrible drugs you mentioned.


  36. I have been on Livalo for over six months with not tolerability issues and my overall cholesterol has come down substantially

  37. I have had a reaction to several statins, and am currently on Crestor 5 mg, which has a powerful effect, lowering my total cholesterol to 100. Crestor works at night, which agrees with me better. I seem to be more tolerant of a statin with a small number of milligrams. Livalo may be even better for me if I can take the one milligram dose.

  38. I am one of those people who can not take the other statins. After having problems with Zocor (muscle aches and cramps, very high createn kinase, sp?)my Dr. tried me on all of the other types of meds for cholesterol I could not take them, same problems. I have been on Zetia for a few years and now problems with it so I am using Livalo (4 days). So far no problems, time will tell.
    I have not tried the red yeast rice. I will look it up and see if it could possibly work for me.

  39. I have been on many statins and had leg cramps. Now I’m on Livalo for a few weeks and have no symptoms.

  40. Hi, I agree with most of what has been said above. Pete gives a nice summary about the available statins. Just a minor point though: there is such a thing as potency. 1 mg of Livalo is more potent than 1 mg of Crestor. Since side effects typically increase with dosage, the statins that are active at lower doses (including atorvastatin and rosuvastatin) are also usually better tolerated.

    But every person is different and there are always exceptional responses to every drug, as Mary points out.

  41. I have been on 2 mg of livalo gor about 4 months
    My total cholestrol went for 220 to 182 over this time and mt LDL has risen from 35 to 49
    So far my doctor is pleased with the results


  42. I took symvistatin initially a couple of years ago and the muscle aches made me feel 10-15 years older. Upon stopping I felt better within 2-3 days. I’ve been taking Livalo for 7 months now and have had none of these aches and my cholesterol is dropping! I’d encourage you to consider prescribing Livalo for those who have had negative reactions to other statins. For some reason this water based statin does not have the same side effects, at lease in my case.

  43. I am on a very low dose of Livalo now but only after having very painful leg cramps in the middle of the night that were apparently caused by the simvastatin (evidenced by the fact that I didn’t have them before taking simvastatin and they went away after I stopped taking them). My doctor told me to stop taking the simvastatin immediately and put me on 1 mg of Livalo, I’m cutting the 2 mg in half. It is controlling my cholesterol at that dosage and I have no more cramps. I’ve only been on Livalo for about 6 months but so far, so good. My total cholesterol wasn’t terribly high to begin with, around 220 or so, but my HDL’s were consistently low keeping my LDL/HDL ratio too high.

  44. Livalo works very well for me.

    My doctor at the center for cholesterol management prescribed Livalo and I have had very good results. I have used other statins in the past and I always felt muscle aches and just an overall feeling of “being old”.

    I have had none of these side effects with Livalo except for some mild digestive problems that are easily overcome.

  45. As a patient who has tried most of the statin drugs, I feel like I am qualified to say this. I think Livalo has major problems that have not yet been uncovered. The side effect that I experienced after taking just one pill was unlike anything I have EVER felt. About 6-8 hours after I took it, I had chest pains, stomach pains and pains throughout my body that made me believe that medicine was going to kill me. I will NEVER touch the stuff again. In fact, I threw the rest of them away! Red yeast rice sounds like it will be my next choice for lowering my cholesterol.

  46. Re your comment rosuvastatin being superior to atorvastatin “by far” I’d say that is an exageration, it leads to slightly lower LDL levels, but I think of them as pretty similar at lowering LDL. Side effects may tilt slightly in favor of rosuvastatin I’ll admit, but again slightly. When atorvastatin goes geneirc I anticipate that it will quickly become the most widely used statin until rosuvastatin gets inexpensive too. Thanks for the comment.

  47. Although I agree with the characterization of pitavastatin (Livalo) as merely a me-too drug…

    Simvastatin has had some problems itself recently. The FDA has recommended that no patient be prescribed simvastatin 80 mg, although patients who are already on the 80–and tolerating it–may be continued. Simvastatin has an unfavorable adverse-effect profile when compared to hydrophilic statins such as pravastatin or rosuvastatin. Additionally, use of gemfibrozil with simvastatin is now contraindicated, and there are dose limitations with some common drugs such as amlodipine.

    Atorvastatin has the greatest abundance of data regarding clinical endpoints; rosuvastatin also has good data regarding endpoints, and also appears to be the best statin overall by far, if one refers to its capacity to improve a patient’s lipid panel (at doses that generally have a low risk of side effects too).

    Rosuvastatin’s apparent superiority is actually leading some to try to bring out a generic early. (Watson has gotten tentative approval for their rosuvastatin zinc [a different salt] and thinks they’ll get it to market despite AstraZeneca’s still-valid patent; it’s up to the courts!)

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