Statin switches may triple patient deaths

GPs should be wary of switching patients from branded to generic statins if a high dose is needed, experts have said.

In a letter to the Lancet, cardiologists from City General Hospital in Stoke-on-Trent suggest that since switching statins, a threefold increased death rate has been noted among patients with previous MI .

In October 2005, local PCTs and the North Staffordshire NHS Trust decided that prescription of 40mg and 80mg atorvastatin (Lipitor) should be suspended and 20-40mg simvastatin used.

An audit of City Hospital patients compared outcomes of 100 patients over a three-month period prior to the switch and a further 121 for three months a year later.

After the switch, the proportion of deaths increased from

5 to 17 per cent. The cardiac readmission rate also rose from 33 to 44 per cent.

But Andrew Riley, head of medicines management at Stoke-on-Trent PCT, said the switch

was only recommended for patients on 10mg atorvastatin.

The DoH has called for PCTs to ensure more than 69 per cent of patients on statins are given a generic version. It could save the NHS £85 million a year. But a DoH spokesperson insisted its policy is not the same as that outlined in the letter from cardiologists in Stoke, and endorses ‘switching from branded to generic statins at comparable dosages'.

A study carried out in a Hertfordshire GP practice monitored the effects of switching

70 patients from 10 or 20mg atorvastatin to an equivalent dose of simvastatin and showed there was no significant change in mean cholesterol four months after the switch, and only one patient switched back because of side effects.

By Rachel Liddle

rachel.liddle@haymarket.com

  • Int J Clin Prac 2007; 61: 15-23
  • Live links at healthcarerepublic.com

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