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Lipid modification - primary and secondary CVD prevention - Management
What dose of statin is recommended?
- Offer simvastatin 40 mg daily for primary and secondary prevention of cardiovascular disease:
- Prescribe pravastatin 40 mg daily if simvastatin is not suitable.
- Consider prescribing a daily dose of less than 40 mg simvastatin in the following situations:
- People who can not tolerate a dose of simvastatin 40 mg daily.
- People with severe renal insufficiency (creatinine clearance less than 30 mL/min): doses above 10 mg daily should be used with caution.
- Risk of drug interaction:
- Avoid exceeding a simvastatin dosage of 10 mg daily in people receiving concomitant medication with ciclosporin, danazol, gemfibrozil (avoid this combination if possible), or a lipid-modifying dose (equal to or greater than 1 g/day) of nicotinic acid.
- Avoid exceeding a simvastatin dose of 20 mg daily in people taking amiodarone or verapamil. These combinations should be avoided unless clinical benefits outweigh the increased risk of myopathy.
- Re-initiation of simvastatin therapy in people who previously experienced elevated creatine kinase levels and muscular symptoms. If indicated, simvastatin should be re-introduced at the lowest dose with close monitoring.
- Simvastatin 80 mg daily should only be offered:
- For people with acute coronary syndrome.
- For secondary prevention, when simvastatin 40 mg daily is insufficient to reach a target total cholesterol level less than 4 mmol/L or a low-density lipoprotein cholesterol level less than 2 mmol/L.
- Atorvastatin 80 mg daily should only be offered for people with acute coronary syndrome.
Clarification / Additional information
- For further information, see:
- The effect of statins on serum total and low-density lipoprotein (LDL) cholesterol is drug- and dose-dependent.
- For a comparison of the potency of different doses for different statins, see evidence on Lipid lowering effects.
Basis for recommendation
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