An Update on Statin Alternatives and Adjuncts

Matthew J Sorrentino


Clin Lipidology. 2012;7(6):721-730. 

In This Article

Intermittent Statin Dosing

The newer statins on the market have longer half-lives than the original statins. Alternative dosing schedules using once-, twice- or three-times a week or every-other-day dosing, have been investigated as methods to reduce myalgias and yet achieve efficacy in lowering LDL-C. Rosuvastatin with a 19-h half-life and atorvastatin with an 11–24-h half-life (parent drug and active metabolite) are particularly useful for this approach.

A pilot study using every-other-day atorvastatin dosing showed comparable LDL-C-lowering efficacy with daily dosing, although the doses used on an every-other-day schedule were higher than the daily dose needed to achieve the same degree of LDL-C lowering.[7] A prospective trial of once-a-week rosuvastatin dosing in individuals with a history of myalgias on statin therapy achieved a >12% lowering of LDL-C and 80% of the patients were able to continue the medication without experiencing myalgias.[8] A retrospective investigation of patients that were not able to tolerate statins determined that over 72% of individuals were able to tolerate an every-other-day regimen of a low dose of rosuvastatin with a mean LDL-C reduction of approximately 34%.[9] There are no outcome studies performed with intermittent dosing of statins so it is not known if this treatment approach will give the same degree of event reduction for the LDL-C level as achieved with daily dosing.

Combination therapy with a statin plus an intestinal agent can be used in individuals that can only tolerate a low-dose statin or an intermittent dosing of the statin. The combination of a statin with ezetimibe or with a resin, such as colesevelam, can achieve an additional 20% LDL-C reduction.[10] Since the intestinal agents do not have systemic exposure, they would not be expected to worsen myalgias.