Statins (or HMG Co-A reductase inhibitors) are the most effective class of cholesterol-lowering medications, also significantly reducing the risk of developing cardiovascular disease in those patients at high risk.
Between 2004 and 2009, the number of patients diagnosed with high cholesterol has doubled, with statins currently the most prescribed of all drugs, in both quantity and cost, on the Pharmaceutical Benefits Scheme in Australia.
In late February 2012, the U.S. Food and Drug Administration (FDA) approved safety label changes for this class of medication. The expansion of advice on the risks of statins relating to memory loss and increased risk of type two diabetes was reported widely in the Australian mainstream media, resulting in concern amongst patients.
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Sleep disturbances and abnormal dreams are not uncommon, current nightmares being reported by approximately 5% of the population. Several etiologies have been suggested, including medications (refer E-Bulletin 25-7).
There have been a number of reports in the literature of sleep disturbance or nightmares related to the use of HMG-CoA reductase inhibitors (statins), most commonly with the more lipophilic agents. In one report, a 72 year old woman taking atorvastatin experienced nightmares 5 days after initiation of the drug. These disappeared on cessation and recurred on rechallenge, correlating to a “definite causality” according to the Naranjo probability scale (refer E-Bulletin 20-11).
Nightmares resolved on discontinuation of treatment. In another report a 55 year old man reported restless nights and nightmares 3 months after simvastatin and metoprolol were initiated. No improvement was observed when the dose of metoprolol was decreased, however, some improvement was noted with simvastatin was replaced with pravastatin and nightmares resolved with metoprolol was replaced by atenolol. More recently, fluvastatin has been associated with nightmares in a 79 year old man. He had previously experienced nightmares during treatment on simvastatin. After cessation of the statin the patient was treated with ezetimibe without complaint.
To read the complete bulletin download the PDF below.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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Grapefruit juice has been extensively studied for its ability to interact with drugs. As a naturally occurring product, the interacting substance(s), not fully identified, appear in different quantities in different fruit. The commercial juicing process forces large quantities of potentially interacting substances normally present in the pith and rind into juice. This has lead to the suggestion that the whole grapefruit is less likely to interact as the fruit juice.
Furanocoumarins have been identified as ingredients in grapefruit juice that inhibit intestinal cytochrome P450 isoenzyme CYP3A4, meaning that there may be increased plasma concentrations of the substrates of CYP3A4 during consumption of the juice. The interaction of grapefruit juice with statins is of interest, due to the common use of these drugs, sometimes as primary prevention in currently healthy people.
The complete bulletin is below:
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The 2009 RGH E-Bulletins are archived here.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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The impact of statins in stroke risk in patients with a history of cerebrovascular disease had been recently evaluated in the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol) trial which was published in 2006. A total of 4731 patients with a stroke or TIA within one to six months were included, other inclusion criteria included LDL levels of 2.6 to 4.9 mmol/L, and absence of coronary heart disease. Patients were randomly assigned to atorvastatin 80mg or placebo and were followed up for a median of 4.9 years with a primary end point being the first nonfatal or fatal stroke.
The SPARCL trial has found that statins exert beneficial effects in reducing occurrence of overall stroke. When subtypes of strokes were analysed, statins were associated with a reduction of ischemic stroke but also a significant increase in haemorrhagic stroke risk. Similar results were observed in a subgroup of patients with a history of cerebrovascular disease in the Heart Protection Study in which the use of statins increased the occurrence of haemorrhagic stroke without an effect on overall stroke incidence.
The rest of the RGH E-Bulletin can be read here.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
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