DTB supports switching to generic simvastatin
There is a strong argument for switching patients from branded statins to generic simvastatin, according to the current issue of Drug
and Therapeutics Bulletin (2007;45:33).
However, switching to simvastatin is not appropriate for all patients,
DTB warns. The potential benefits, unwanted effects and costs need to
be considered, along with special circumstances such as renal impairment
and drugs being co-prescribed.
Nonetheless, simvastatin should be the first-line option for most patients
with established cardiovascular disease, it says. Atorvastatin (Lipitor)
should be reserved for second-line treatment or for patients intolerant
of simvastatin. Patients who experience drug interactions with simvastatin
may fare better with pravastatin, but the weaker lipid-lowering effects
of pravastatin make it a less attractive first choice, DTB argues.
“Switching the million people in the UK currently on atorvastatin
10mg or 20mg daily to simvastatin 40mg daily, plus using simvastatin
40mg
daily for the 1.6 million prescriptions of statins to meet the NICE guidelines
for primary prevention, could save as much as £2bn over the next
five years,” it suggests.
This month’s DTB also provides an update on drugs for hyperactivity
in childhood (ibid, p37). It recommends that drug treatment should only
be used as an adjunct to other interventions and that, since current
evidence does not allow clear distinction between methylphenidate, dexamfetamine
and atomoxetine in terms of efficacy, the longer history of use with
methylphenidate is a compelling reason for preferring it as a first choice.
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