各種 Statin 降血脂藥的比較

Lovastatin
(Mevacor)

Pravastatin
(Mevalotin)

Simvastatin
(Zocor)

Fluvastatin
(Lescol)

Atorvastatin
(Lipitor)

Rosuvastatin
(Crestor)

Potency:
Average Decrease in LDL-Chol.

20 mg: 29%
40 mg: 31%
80 mg: 40%-48%

10 mg: 19%
20 mg: 24%
40 mg: 34%
80 mg: 40%

10 mg: 28%
20 mg: 35%
40 mg: 40%
80 mg: 48%

20 mg: 17%
40 mg: 23%
80 mg: 33%

10 mg: 38%
20 mg: 46%
40 mg: 51%
80 mg: 54%

5 mg: 43%
10 mg: 50%
20 mg: 53%
40 mg: 62%

Renal Function

Use lower doses for severe renal impairment (creatinine clearance < 30 mL/min).

Use lower doses for significant renal impairment (reduce initial dose to 10 mg daily).

Use lower doses for severe renal impairment (reduce initial dose to 5 mg daily).

No dose adjustment necessary for reduced renal function. (not studied at doses >40 mg in patients with severe renal impairment).

No dose adjustment necessary for reduced renal function.

Use lower doses for severe renal impairment (creatinine clearance <30 mL/min).

Liver Function Monitoring

LFTs at baseline. Also, at 6 and 12 weeks after start of therapy or elevation of dose. Then every 6 months thereafter.

LFTs at baseline. Also, prior to elevation of dose, and when otherwise clinically indicated.

LFTs at baseline and thereafter when clinically indicated. Patients titrated to 80 mg should receive an additional test before titration, 3 months after titration, and every 6 months for the 1st year.

LFTs at baseline. Also, at 12 weeks after initiation or elevation of dose.

LFTs at baseline. Also, at 12 weeks following both the initiation of therapy and dose elevation. Check every 6 months thereafter.

LFTs at baseline. Also, at 12 weeks after initiation or elevation of dose. Then every 6 months thereafter.

Drug Interactions

Metabolized by CYP3A4 enzyme system. Watch for interactions with drugs that inhibit this enzyme including: erythromycin, clarithromycin, ketoconazole, verapamil, diltiazem, nefazodone, fluvoxamine, cyclosporine, grapefruit juice, etc.

Not significantly metabolized by cytochrome P450 and may be less likely to be involved in drug interactions. Cyclosporine can increase pravastatin levels.

Metabolized by CYP3A4 enzyme system. Watch for interactions with drugs that inhibit this enzyme including: amiodarone, erythromycin, clarithromycin, ketoconazole, verapamil, diltiazem, nefazodone, fluvoxamine, cyclosporine, grapefruit juice, etc.

Metabolized primarily by CYP2C9 enzyme system and may be less likely to be involved in drug interactions. Fluvastatin can increase levels of phenytoin. Rifampin can lower fluvastatin levels.

Metabolized by CYP3A4 enzyme system, but less than lovastatin and simvastatin. Some drugs that inhibit CYP3A4 include: erythromycin, clarithromycin, ketoconazole, verapamil, nefazodone, fluvoxamine, cyclosporine, grapefruit juice, etc.

Not significantly metabolized by cytochrome P450 and may be less likely to be involved in drug interactions. Use lower doses for patients taking cyclosporine or gemfibrozil (both drugs increase rosuvastatin levels). Rosuvastatin with warfarin results in increased INR.

Food Interactions

Take with dinner.

Take without regard to meals.

Take without regard to meals.

Take without regard to meals.

Take without regard to meals.

Take without regard to meals.