Safety of HMG-CoA reductase inhibitors: Focus on atorvastatin

Statins effectively lower LDL-cholesterol and some members of this class ha ve been shown to reduce the risk of major cardiovascular events and total m ortality in patients with or at risk for coronary heart disease. Statins ar e in general well tolerated. Withdrawal rates related to adverse events are low (less than or equal to3%). The most common adverse events are mild gas trointestinal symptoms. Elevated serum transaminase levels occur infrequent ly (less than or equal to1.5%). These are generally asymptomatic, reversibl e and rarely require drug withdrawal. Statins do not cause adverse endocrin e effects, do not alter glycemic control in diabetic patients, and do not i ncrease cancer risk. Dose-related myopathy and/or rhabdomyolysis also occur s very rarely, although the risk is increased by concomitant administration of cyclosporine, niacin, fibrates, or by CYP3A4 isoenzyme inhibitors (e.g. erythromycin, systemic azole antifungal agents etc.) with statins metaboli zed by this isoenzyme. The pharmacokinetics of the individual statin should be considered in patients receiving polypharmacological treatments, to min imize the risk of unfavorable drug interactions. Atorvastatin is well toler ated in long-term treatment of dyslipidemia and is characterized by a safet y profile similar to the other available statins.