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Feb 27:FDA advisory about statins, diabetes, memory impairment and LFT's
Section:  Nursing

 

February 27, 2011

Wow! the FDA statin advisory is about more than the potential for type 2 Diabetes....read on... another excellent reminder to monitor patients carefully for side effects with any medications.

The FDA is" advising consumers and health care professionals that:

  • Routine monitoring of liver enzymes in the blood, once considered standard procedure for statin users, is no longer needed. Such monitoring has not been found to be effective in predicting or preventing the rare occurrences of serious liver injury associated with statin use.
  • Cognitive (brain-related) impairment, such as memory loss, forgetfulness and confusion, has been reported by some statin users.
  • People being treated with statins may have an increased risk of raised blood sugar levels and the development of Type 2 diabetes.
  • Some medications interact with lovastatin (brand names include Mevacor) and can increase the risk of muscle damage.

 

This new information should not scare people off statins, says Amy G. Egan, M.D., M.P.H., deputy director for safety in FDA’s Division of Metabolism and Endocrinology Products (DMEP). “The value of statins in preventing heart disease has been clearly established,” she says. “Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects.”

 

FDA will be changing the drug labels of popular statin products to reflect these new concerns. (These labels are not the sticker attached to a prescription drug bottle, but the package insert with details about a prescription medication, including side effects.)

 

The statins affected include:

 

  • Altoprev (lovastatin extended-release)
  • Crestor (rosuvastatin)
  • Lescol (fluvastatin)
  • Lipitor (atorvastatin)
  • Livalo (pitavastatin)
  • Mevacor (lovastatin)
  • Pravachol (pravastatin)
  • Zocor (simvastatin).

 

Products containing statins in combination with other drugs include:

 

  • Advicor (lovastatin/niacin extended-release)
  • Simcor (simvastatin/niacin extended-release)
  • Vytorin (simvastatin/ezetimibe).

 

Liver Injury Called Rare

 

FDA has found that liver injury associated with statin use is rare but can occur. Patients are advised to consult their health care professional if they have symptoms that include unusual fatigue, loss of appetite, right upper abdominal discomfort, dark urine or yellowing of the skin or whites of the eyes.

 

Statins work in the liver to reduce the production of cholesterol, a waxy substance that can form plaque on the walls of the arteries and keep the heart from getting the blood it needs.

 

Egan explains that there had been signals in early clinical trials of possible liver damage tied to statin use, so health care professionals were advised to regularly test their patients’ liver enzyme levels. However, she says, such damage is rare, and the tests are not effective at predicting or preventing who will develop this rare side effect.

 

So FDA is now recommending that liver enzyme tests be performed before statin treatment begins and then as needed if there are symptoms of liver damage.

 

Reports of Memory Loss

 

FDA has been investigating reports of cognitive impairment from statin use for several years. The agency has reviewed databases that record reports of bad reactions to drugs and statin clinical trials that included assessments of cognitive function.

 

The reports about memory loss, forgetfulness and confusion span all statin products and all age groups. Egan says these experiences are rare but that those affected often report feeling “fuzzy” or unfocused in their thinking.

 

In general, the symptoms were not serious and were reversible within a few weeks after the patient stopped using the statin. Some people affected in this way had been taking the medicine for a day; others had been taking it for years.

 

The Risk of Diabetes

 

 “Clearly we think that the heart benefit of statins outweighs this small increased risk,” says Egan. But what this means for patients taking statins and the health care professionals prescribing them is that blood-sugar levels may need to be assessed after instituting statin therapy.

 

The Potential for Muscle Damage

 

Some drugs interact with statins in a way that increases the risk of muscle injury called myopathy, characterized by unexplained muscle weakness or pain. Egan explains that some new drugs are broken down (metabolized) through the same pathways in the body that statins follow. This increases both the amount of statin in the blood and the risk of muscle injury.

FDA is revising the drug label for Lovastatin to clarify the risk of myopathy. The label will reflect what drugs should not be taken at the same time, and the maximum lovastatin dose if it is not possible to avoid use of those other drugs."

Patients and health care professionals should report negative side effects from statin use to FDA’s MedWatch Adverse Event Reporting Program6.

This article appears on FDA's Consumer Update page http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm

In addition , the FDA added several restrictions to the lovastatin (Mevacor) label, including 10 drugs or drug classes that are contraindicated with lovastatin.

Drugs contraindicated with lovastatin include:

       Itrraconazole

·         Ketoconazole

·         Posaconazole

·         Erythromycin

·         Clarithromycin

·         Telithromycin

·         HIV protease inhibitors

·         Boceprevir

·         Telaprevir

·         Nefazodone

The new lovastatin label also states that cyclosporine and gemfibrozil should be "avoided" when taking lovastatin, and lovastatin dosing should be limited to 20 mg for patients taking danazol, diltiazem, or verapamil. Patients taking amiodarone should limit lovastatin to 40 mg daily.

 

MEMBER COMMENTS
Re: Feb 27:FDA advisory about statins, diabetes, memory impairment and LFT's

Thanks for sharing this information. In my mind, it's yet another reason to encourage people to make lifestyle changes so that they can avoid taking medications, or decrease the amount of medication they need. Perhaps if people understand the potentially dangerous side effects, they'll be more willing to stick with lifestyle changes.

Does anyone know how taking statins increases risk of developing T2? I don't understand the mechanism and need to know more about this.

Re: Feb 27:FDA advisory about statins, diabetes, memory impairment and LFT's

I agree with you Lynn.  What is the mechanism to start the glucose rise, is it the same degree in each patient?  Why do some not develop diabetes on the statins and others do. Funny how well accepted statins have been for so long and now a new consideration.  Caring for our patients is a constantly moving target! 

Re: Feb 27:FDA advisory about statins, diabetes, memory impairment and LFT's

It's been awhile since I've done any biochem!  Here's the response to an inquiry in JACC.  But the real question is: ha's an isoprenoids??  :-)

 

http://content.onlinejacc.org/cgi/reprint/56/8/680.pdf

 

We agree that it is of significant clinical interest to understand potential mechanisms by which some statins have detrimental effects on

glucose homeostasis whereas other statins improve the metabolic phenotype. Sukhija et al. (2

 

uptake via glucose transporter type 4 in adipocytes and contribute to insulin release.

Recent experimental studies have demonstrated that compared

with hydrophilic statins, lipophilic statins have pleiotropic actions

that cause unfavorable metabolic effects, such as reduction of

insulin secretion and exacerbation of insulin resistance (

3,4). Sattaret al. (5) showed that risk for the development of diabetes with

statins is highest in older participants, while trials with pravastatin

have reduced the development of diabetes in participants below a

mean age of 65 years. We previously observed that pravastatin

improves insulin sensitivity, whereas simvastatin worsens insulin

resistance despite comparable improvements in lipid profiles and

endothelium-dependent vasodilation in patients with hypercholesterolemia

(6). These differential metabolic actions of lipophilic and hydrophilic statins are consistent with recent meta-analyses (7).

Among plausible mechanisms that deserve further investigation are potential central nervous system actions of lipophilic statins to impair glucose homeostasis.

Certainly, mechanisms by which atorvastatin treatment results in increased fasting insulin and glycated hemoglobin levels require further investigation. Our observations are consistent with analyses of atorvastatin therapy and the incidence of diabetes (

8). It is

particularly important to investigate mechanisms of differential metabolic effects of various statins in patients at risk for metabolic diseases, including diabetes, obesity, and metabolic syndrome.

 

*Kwang Kon Koh, MD, PhD

 

Michael J. Quon, MD, PhD

*Division of Cardiology Gachon University Gil Medical Center

1198 Kuwol-dong, Namdong-gu South Korea E-mail: kwangk@gilhospital

Incheon 405-760

If you got this far, here's some info on Isoprenoids!

http://www.rpi.edu/dept/bcbp/molbiochem/MBWeb/mb2/part1/cholesterol.htm

 

 

 

 

 

 

 

 

Re: Feb 27:FDA advisory about statins, diabetes, memory impairment and LFT's

Sorry for the last post; formating problems at 5:38 am, before the first cup of coffee!

Re: Feb 27:FDA advisory about statins, diabetes, memory impairment and LFT's

Thanks for the information Joan. I didn't realize that not all statins increased risk of diabetes, and that some actually seem protective. This area definitely deserves more analysis.