Published: July 1998

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Dose Titration Recommended When Switching Statins

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Prescriber Update 16: 36
July 1998

Medsafe Editorial Team

Difficulties encountered by prescribers when converting a patient from pravastatin or simvastatin to fluvastatin were highlighted by a series of case reports reviewed at a recent meeting of the Medicines Adverse Reactions Committee (MARC). The reports included two cases where inadequate control of cholesterol concentration was found after a switch to fluvastatin. In one case monitoring of effect and dose titration had not occurred; in the other case it was not possible to determine if dose titration of fluvastatin had occurred.

As case studies indicate that after withdrawal of a statin cholesterol levels can double within 2 weeks, the MARC recommends that when switching a patient from one statin to another, the changeover should be managed in much the same way as statin therapy is initiated. Cholesterol levels should be monitored and the dosage titrated until the cholesterol concentration is within the normal range. The frequency of monitoring is dependent on the degree of risk of cardiovascular events in each patient. In patients at high absolute risk of cardiovascular events it may be appropriate to have the patient’s cholesterol checked and dosage adjusted at weekly intervals until the level of control is adequate and lipid levels are stable for at least two to four weeks.

Monitoring should occur for any change in prescribing within the therapeutic group of lipid lowering agents, not only for a change to fluvastatin.