GPs warn generic statins up patient side-effects

A rise in the prescribing of generic statins helped to cut total drug spending in England by £50m in 2008, but GPs warned that rising use of high-dose simvastatin could increase side-effects.

The biggest increase in prescribing was in drugs for cardiovascular disease, where prescribing rates for simvastatin rose by 15%, according to data released last week by the NHS Information Centre.

The increase has helped to reduce total drug spending from £8.37bn in 2007 to £8.32bn for 2008. This came despite 46m more drugs being prescribed in 2008.

Overall, a total of 33.8m prescriptions were made for simvastatin in 2008.

This is an increase of 15.3% on 2007 prescribing levels, with simvastatin now accounting for half of all statins that are prescribed in England.

During the same period, prescribing of rosuvastatin increased by only 4.5%, while pravastatin prescribing rose by just 1.8%. Prescribing of atorvastatin fell by 4% on 2007 figures.

Although simvastatin 40mg was the most commonly prescribed statin, with 18.8m prescriptions, the data shows that there was a 16% increase in prescribing of simvastatin 80mg.

A total of 346,800 prescriptions were made for the drug in 2008, despite concerns over its safety.

Last year, the finding of the SEARCH trial showed that high-dose simvastatin produced only a small additional reduction in LDL cholesterol of 0.35mmol/l compared with the 20mg dose, but increased the risk of myopathy.

North Yorkshire GP Dr Terry McCormack, former chairman of the Primary Care Cardiovascular Society, said: ‘Simvastatin 40mg is a good drug with very little side-effects. The side-effects are seen when you go up to the 80mg doses.'

Berkshire GP Dr George Kassianos, a member of the British Cardiology Society, said: ‘Generic simvastatin must be our first option. But if simvastatin 40mg does not deliver LDL cholesterol levels below 2mmol/l, the next step is not to use simvastatin 80mg because of the increased risk of side-effects.'

He added that, taking into consideration cost and LDL reduction, GPs should switch to a lower dose of another statin and titrate up if necessary.

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