The authors of a Drug Therapy Bulletin reviewhave reiterated advice that generic simvastatin is currently the mostcost-effective statin and should be regarded as the first-line optionfor most patients.
The review discusses the relativemerits of different statins in addressing cardiovascular risk, andmakes suggestions for statins other than simvastatin.
Theysay that for patients in whom drug interactions are a problem,interactions may be less likely if pravastatin is used instead.However, the weaker lipid-lowering effects of pravastatin make it aless attractive first choice.
Meanwhile, atorvastatinshould be reserved for second-line treatment or for patients intolerantof simvastatin. Many patients currently taking atorvastatin could beswitched to simvastatin, to gain similar benefits at lower cost.
Finally,there are very limited clinical trial data for fluvastatin orrosuvastatin; these are much more expensive than simvastatin; theauthors said “we can see no reason for using them in routinemanagement”.
Drug Therap Bull 2007;May;45(5)