Editing Statin (section)

==Available forms==
The statins are divided into two groups: [[fermentation (biochemistry)|fermentation]]-derived and [[chemical synthesis|synthetic]]. Some specific types are listed in the table below. Note that the associated brand names may vary between countries.

{| class="wikitable sortable" style="background:white"
|-
!Statin
!Image
!Brand name
!Derivation
!Metabolism<ref name=safety />
! Half-life
|-
| [[Atorvastatin]] || [[Image:Atorvastatin.svg|center|150px|class=skin-invert-image]] || Arkas, Ator, Atoris, Lipitor, Torvast, Totalip || Synthetic || [[CYP3A4]] || 14–19 hours.<ref name="McKenney Ganz Wiggins Saseen 2009 pp. 253–280">{{cite book | vauthors = McKenney JM, Ganz P, Wiggins BS, Saseen JS | title=Clinical Lipidology | chapter=Statins | publisher=Elsevier | year=2009 | isbn=978-1-4160-5469-6 | doi=10.1016/b978-141605469-6.50026-3 | pages=253–280 | quote=The elimination half-life of the statins varies from 1 to 3 hours for lovastatin, simvastatin, pravastatin, and fluvastatin, to 14 to 19 hours for atorvastatin and rosuvastatin (see Table 22-1). The longer the half-life of the statin, the longer the inhibition of reductase and thus a greater reduction in LDL cholesterol. However, the impact of inhibiting cholesterol synthesis persists even with statins that have a relatively short half-life. This is due to their ability to reduce blood levels of lipoproteins, which have a half-life of approximately 2 to 3 days. Because of this, all statins may be dosed once daily. The preferable time of administration is in the evening just before the peak in cholesterol synthesis. }}</ref>
|-
| [[Cerivastatin]] || [[Image:Cerivastatin.svg|center|150px|class=skin-invert-image]] || Baycol, Lipobay (withdrawn from the market in August 2001 due to risk of serious [[rhabdomyolysis]]) || Synthetic ||various [[CYP3A]] isoforms<ref>{{cite journal | vauthors = Boberg M, Angerbauer R, Fey P, Kanhai WK, Karl W, Kern A, Ploschke J, Radtke M | title = Metabolism of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and of cytochrome P450 isozymes involved | journal = Drug Metabolism and Disposition | volume = 25 | issue = 3 | pages = 321–331 | date = March 1997 | pmid = 9172950 | url = http://dmd.aspetjournals.org/cgi/pmidlookup?view=long&pmid=9172950 }}</ref> ||
|-
| [[Fluvastatin]] || [[Image:Fluvastatin.svg|center|150px|class=skin-invert-image]] || Lescol, Lescol XL, Lipaxan, Primesin || Synthetic || [[CYP2C9]] || 1–3 hours.<ref name="McKenney Ganz Wiggins Saseen 2009 pp. 253–280"/>
|-
| [[Lovastatin]] || [[Image:Lovastatin.svg|center|150px|class=skin-invert-image]] || Altocor, Altoprev, Mevacor || Naturally occurring, fermentation-derived compound. It is found in [[oyster mushrooms]] and [[red yeast rice]] || [[CYP3A4]] || 1–3 hours.<ref name="McKenney Ganz Wiggins Saseen 2009 pp. 253–280"/>
|-
| [[Mevastatin]] || [[Image:Mevastatin.svg|center|150px|class=skin-invert-image]] || Compactin || Naturally occurring compound found in [[red yeast rice]] || [[CYP3A4]] ||
|-
| [[Pitavastatin]] || [[Image:Pitavastatin.svg|center|150px|class=skin-invert-image]] || Alipza, Livalo, Livazo, Pitava, Zypitamag || Synthetic || [[CYP2C9]] and [[CYP2C8]] (minimally) ||
|-
| [[Pravastatin]] || [[Image:Pravastatin.svg|center|150px|class=skin-invert-image]] || Aplactin, Lipostat, Prasterol, Pravachol, Pravaselect, Sanaprav, Selectin, Selektine, Vasticor || Fermentation-derived (a fermentation product of bacterium ''Nocardia autotrophica'') || Non-CYP<ref>{{cite journal | vauthors = Jacobsen W, Kirchner G, Hallensleben K, Mancinelli L, Deters M, Hackbarth I, Benet LZ, Sewing KF, Christians U | title = Comparison of cytochrome P-450-dependent metabolism and drug interactions of the 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors lovastatin and pravastatin in the liver | journal = Drug Metabolism and Disposition | volume = 27 | issue = 2 | pages = 173–179 | date = February 1999 | pmid = 9929499 | url = http://dmd.aspetjournals.org/cgi/pmidlookup?view=long&pmid=9929499 | access-date = 8 November 2018 | url-status = dead | archive-url = https://web.archive.org/web/20210826102128/https://dmd.aspetjournals.org/content/27/2/173.long | archive-date = 26 August 2021 }}</ref> || 1–3 hours.<ref name="McKenney Ganz Wiggins Saseen 2009 pp. 253–280"/>
|-
| [[Rosuvastatin]] || [[Image:Rosuvastatin structure.svg|center|150px|class=skin-invert-image]] || Colcardiol, Colfri, Crativ, Crestor, Dilivas, Exorta, Koleros, Lipidover, Miastina, Provisacor, Rosastin, Simestat, Staros || Synthetic || [[CYP2C9]] and [[CYP2C19]] || 14–19 hours.<ref name="McKenney Ganz Wiggins Saseen 2009 pp. 253–280"/>
|-
| [[Simvastatin]] || [[File:Simvastatin.svg|center|150px|class=skin-invert-image]] || Alpheus, Corvatas, Krustat, Lipenil, Lipex, Liponorm, Medipo, Omistat, Rosim, Setorilin, Simbatrix, Sincol, Sinvacor, Sinvalip, Sivastin, Sinvat, Vastgen, Vastin, Xipocol, Zocor || Fermentation-derived (simvastatin is a synthetic derivate of a fermentation product of ''[[Aspergillus terreus]]'') || [[CYP3A4]] || 1–3 hours.<ref name="McKenney Ganz Wiggins Saseen 2009 pp. 253–280"/>
|-
| [[Atorvastatin/amlodipine|Atorvastatin + amlodipine]] || || Caduet, Envacar || Combination therapy: statin + [[Calcium channel blocker|calcium antagonist]] || ||
|-
| [[Atorvastatin]] + [[perindopril]] + [[amlodipine]] || || Lipertance, Triveram<ref>{{cite web|language=it|url=https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000049_043427_FI.pdf&retry=0&sys=m0b1l3|format=PDF|title=Triveram|access-date=7 February 2020|archive-date=12 August 2020|archive-url=https://web.archive.org/web/20200812000033/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000049_043427_FI.pdf&retry=0&sys=m0b1l3|url-status=live}}</ref><ref>{{cite web|language=it|url=https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000049_043427_RCP.pdf&retry=0&sys=m0b1l3|format=PDF|title=Triveram (2)|access-date=7 February 2020|archive-date=11 August 2020|archive-url=https://web.archive.org/web/20200811235437/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000049_043427_RCP.pdf&retry=0&sys=m0b1l3|url-status=live}}</ref><ref>{{cite web|language=it|url=https://www.gazzettaufficiale.it/eli/id/2019/10/10/19A06231/SG|title=Riclassificazione del medicinale per uso umano 'Triveram', ai sensi dell'articolo 8, comma 10, della legge 24 dicembre 1993, n. 537. (Determina n. DG/1422/2019). (19A06231)|work=GU Serie Generale n.238|date=10 October 2019|access-date=7 February 2020|archive-date=10 August 2020|archive-url=https://web.archive.org/web/20200810161745/https://www.gazzettaufficiale.it/eli/id/2019/10/10/19A06231/SG|url-status=live}}</ref> || Combination therapy: statin + [[ACE inhibitor]] + [[Calcium channel blocker|calcium antagonist]] || ||
|-
| [[Niacin/lovastatin|Lovastatin + niacin extended-release]] || || Advicor, Mevacor || Combination therapy || ||
|-
| [[Rosuvastatin]] + [[ezetimibe]] || || Cholecomb, Delipid Plus, Росулип плюс, Rosulip, Rosumibe, Viazet<ref>{{cite web|language=it|url=https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_001820_043496_FI.pdf&retry=0&sys=m0b1l3|format=PDF|title=Cholecomb|access-date=7 February 2020|archive-date=26 August 2021|archive-url=https://web.archive.org/web/20210826102128/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_001820_043496_FI.pdf&retry=0&sys=m0b1l3|url-status=live}}</ref><ref>{{cite web|language=it|url=https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_001820_043496_RCP.pdf&retry=0&sys=m0b1l3|format=PDF|title=Cholecomb (2)|access-date=7 February 2020|archive-date=12 August 2020|archive-url=https://web.archive.org/web/20200812011759/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_001820_043496_RCP.pdf&retry=0&sys=m0b1l3|url-status=live}}</ref><ref>{{cite web|language=it|url=https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000194_045350_RCP.pdf&retry=0&sys=m0b1l3|format=PDF|title=Rosumibe|access-date=7 February 2020|archive-date=12 August 2020|archive-url=https://web.archive.org/web/20200812003142/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000194_045350_RCP.pdf&retry=0&sys=m0b1l3|url-status=live}}</ref><ref>{{cite web|language=it|url=https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000194_045350_FI.pdf&retry=0&sys=m0b1l3|format=PDF|title=Rosumibe (2)|access-date=7 February 2020|archive-date=12 August 2020|archive-url=https://web.archive.org/web/20200812003343/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000194_045350_FI.pdf&retry=0&sys=m0b1l3|url-status=live}}</ref> || Combination therapy: statin + [[cholesterol absorption inhibitor]] || ||
|-
| [[Ezetimibe/simvastatin|Simvastatin + ezetimibe]] || || Goltor, Inegy, Staticol, Vytorin, Zestan, Zevistat || Combination therapy: statin + [[cholesterol absorption inhibitor]] || ||
|-
| [[Niacin/simvastatin|Simvastatin + niacin extended-release]] || || Simcor, Simcora || Combination therapy || ||
|}

LDL-lowering potency varies between agents. Cerivastatin is the most potent (withdrawn from the market in August 2001 due to risk of serious rhabdomyolysis), followed by (in order of decreasing potency) rosuvastatin, atorvastatin, simvastatin, lovastatin, pravastatin, and fluvastatin.<ref>{{cite journal | vauthors = Shepherd J, Hunninghake DB, Barter P, McKenney JM, Hutchinson HG | title = Guidelines for lowering lipids to reduce coronary artery disease risk: a comparison of rosuvastatin with atorvastatin, pravastatin, and simvastatin for achieving lipid-lowering goals | journal = The American Journal of Cardiology | volume = 91 | issue = 5A | pages = 11C–17C; discussion 17C–19C | date = March 2003 | pmid = 12646338 | doi = 10.1016/S0002-9149(03)00004-3 }}</ref> The relative potency of pitavastatin has not yet been fully established, but preliminary studies indicate a potency similar to rosuvastatin.<ref>{{cite journal | vauthors = Baldinelli L, Biselli R, Fattorossi A | title = Influence of ST 789 on murine thymocytes: a flow cytometry study of thymocyte subset distribution and of intracellular free Ca++ increase upon activation. Murine thymocytes and ST 789 | journal = Thymus | volume = 19 | issue = 2 Suppl 1 | pages = S53–S61 | date = February 2005 | pmid = 1585420 | doi = 10.1111/j.1742-1241.2005.00461.x | s2cid = 221814440 }}</ref>

[[Image:Pleurotus ostreatus JPG7.jpg|thumb|right|The [[oyster mushroom]], a culinary mushroom, naturally contains lovastatin.]]

Some types of statins are naturally occurring, and can be found in such foods as [[oyster mushrooms]] and [[red yeast rice]]. Randomized controlled trials have found these foodstuffs to reduce circulating cholesterol, but the quality of the trials has been judged to be low.<ref name="pmid17302963">{{cite journal | vauthors = Liu J, Zhang J, Shi Y, Grimsgaard S, Alraek T, Fønnebø V | title = Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials | journal = Chinese Medicine | volume = 1 | issue = 1 | pages = 4 | date = November 2006 | pmid = 17302963 | pmc = 1761143 | doi = 10.1186/1749-8546-1-4 | doi-access = free | title-link = doi }}</ref>
Due to patent expiration, most of the block-buster branded statins have been generic since 2012, including atorvastatin, the largest-selling<ref>{{Cite journal |last1=Jackevicius |first1=Cynthia A. |last2=Chou |first2=Mindy M. |last3=Ross |first3=Joseph S. |last4=Shah |first4=Nilay D. |last5=Krumholz |first5=Harlan M. |date=19 January 2012 |title=Generic Atorvastatin and Health Care Costs |journal=New England Journal of Medicine  |volume=366 |issue=3 |pages=201–204 |doi=10.1056/NEJMp1113112 |issn=0028-4793 |pmc=3319770 |pmid=22149736}}</ref> branded drug.<ref>{{cite web | vauthors = Fang J | title=Patent expires today on pharmaceutical superstar Lipitor | website=ZDNet | date=31 October 2019 | url=https://www.zdnet.com/article/patent-expires-today-on-pharmaceutical-superstar-lipitor/ | archive-url=https://web.archive.org/web/20191031085907/https://www.zdnet.com/article/patent-expires-today-on-pharmaceutical-superstar-lipitor/ | archive-date=31 October 2019 | url-status=live | access-date=31 October 2019 }}</ref><ref>{{cite web | title=Sandoz launches authorized fluvastatin generic in US | website=GaBI Online | date=31 October 2019 | url=http://www.gabionline.net/Generics/News/Sandoz-launches-authorized-fluvastatin-generic-in-US | archive-url=https://web.archive.org/web/20191031090130/http://www.gabionline.net/Generics/News/Sandoz-launches-authorized-fluvastatin-generic-in-US | archive-date=31 October 2019 | url-status=live | access-date=31 October 2019}}</ref><ref>{{cite press release | title=Teva Announces Final Approval of Lovastatin Tablets | website=Teva Pharmaceutical Industries Ltd. | date=31 October 2019 | url=https://www.tevapharm.com/news/teva_announces_final_approval_of_lovastatin_tablets_12_01.aspx | archive-url=https://web.archive.org/web/20191031090617/https://www.tevapharm.com/news/teva_announces_final_approval_of_lovastatin_tablets_12_01.aspx | archive-date=31 October 2019 | url-status=live | access-date=31 October 2019}}</ref><ref>{{cite web | title=FDA OKs Generic Version of Pravachol | website=WebMD | date=25 April 2006 | url=https://www.webmd.com/cholesterol-management/news/20060425/fda-oks-generic-version-pravachol | access-date=31 October 2019 | archive-date=31 October 2019 | archive-url=https://web.archive.org/web/20191031090912/https://www.webmd.com/cholesterol-management/news/20060425/fda-oks-generic-version-pravachol | url-status=live }}</ref><ref>{{cite news | title=Generic Crestor Wins Approval, Dealing a Blow to AstraZeneca | website=[[The New York Times]] | date=21 July 2016 | url=https://www.nytimes.com/2016/07/21/business/generic-crestor-wins-approval-dealing-a-blow-to-astrazeneca.html | access-date=31 October 2019 | archive-date=31 October 2019 | archive-url=https://web.archive.org/web/20191031092230/https://www.nytimes.com/2016/07/21/business/generic-crestor-wins-approval-dealing-a-blow-to-astrazeneca.html | url-status=live }}</ref><ref>{{cite news | vauthors=Wilson D | title=Drug Firms Face Billions in Losses as Patents End | newspaper=[[The New York Times]] | date=6 March 2011 | url=https://www.nytimes.com/2011/03/07/business/07drug.html | access-date=31 October 2019 | archive-date=22 November 2019 | archive-url=https://web.archive.org/web/20191122014528/https://www.nytimes.com/2011/03/07/business/07drug.html | url-status=live }}</ref><ref>{{cite news | vauthors=Berenson A | title=Merck Loses Protection for Patent on Zocor | newspaper=[[The New York Times]] | date=23 June 2006 | url=https://www.nytimes.com/2006/06/23/business/23statin.html | access-date=31 October 2019 | archive-date=14 January 2015 | archive-url=https://web.archive.org/web/20150114212534/http://www.nytimes.com/2006/06/23/business/23statin.html?_r=0 | url-status=live }}</ref>

{| class=wikitable
|+ Statin equivalent dosages
|-
!% LDL reduction (approx.)|| Atorvastatin|| Fluvastatin ||Lovastatin ||Pravastatin ||Rosuvastatin||Simvastatin
|-
| 10–20% || –    || 20&nbsp;mg || 10&nbsp;mg || 10&nbsp;mg || –    || 5&nbsp;mg
|-
| 20–30% || –    || 40&nbsp;mg || 20&nbsp;mg || 20&nbsp;mg || –    || 10&nbsp;mg
|-
| 30–40% || 10&nbsp;mg || 80&nbsp;mg || 40&nbsp;mg || 40&nbsp;mg ||  5&nbsp;mg || 20&nbsp;mg
|-
| 40–45% || 20&nbsp;mg ||  –   || 80&nbsp;mg || 80&nbsp;mg || 5–10&nbsp;mg || 40&nbsp;mg
|-
| 46–50% || 40&nbsp;mg ||  –   ||  –   ||  –   || 10–20&nbsp;mg || 80&nbsp;mg{{efn|80&nbsp;mg dose no longer recommended due to increased risk of rhabdomyolysis.}}
|-
| 50–55% || 80&nbsp;mg ||  –   ||  –   ||  –   || 20&nbsp;mg ||  –
|-
| 56–60% ||  –   ||  –   ||  –   ||  –   || 40&nbsp;mg ||  –
|-
!colspan=7 | Starting dose
|-
|Starting dose || 10–20&nbsp;mg ||20&nbsp;mg || 10–20&nbsp;mg || 40&nbsp;mg || 10&nbsp;mg; 5&nbsp;mg if hypothyroid, >65 yo, Asian ||  20&nbsp;mg
|-
|If higher LDL reduction goal || 40&nbsp;mg if >45% || 40&nbsp;mg if >25% || 20&nbsp;mg if >20% || – || 20&nbsp;mg if LDL >190&nbsp;mg/dL (4.87&nbsp;mmol/L) || 40&nbsp;mg if >45%
|-
|Optimal timing || Anytime || Evening || With evening meals || Anytime || Anytime || Evening
|}
{{notelist}}