Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics. This week:
Statins and the elderly
HMG Co reductase inhibitors are amongst the most commonly prescribed drugs in Australia, and ae frequently encountered on medication charts in aged care facilities. These agents are used to treat hyperlipidaemia and thus to prevent myocardial infarctions and strokes, but there are special considerations for older people.
- Evidence for the use of statins in primary prevention for older people is less compelling than for other age groups. In many cases the relatively limited life expectancy of an older person (for example a person in their late 80s) means that the prospective benefit that might be gained from primary prevention with a statin may in fact be less than that for a younger person, warranting reconsideration of the risk benefit ratio.
- For older people it is reasonable to reconsider the targets to which statin treatment is adjusted against. Aggressive treatment used to drive serum lipid concentrations to very low levels may not be justifiable for an older person. Under the circumstances, used at a lower dose or even discontinuation of a statin could be considered.
- Statin medications are associated with the range of serious adverse effects that can impact the lives of older people. Myalgia and myopathy can cause significant discomfort, but may also increase the risk of falls and subsequent injury. Some older people can experience impaired cognition in association with statin treatment, and it is important to monitor for these effects.
- Statins may be involved with various drug interactions that increase the risk of serious toxicity. Administration of some statins, in particular simvastatin and atorvastatin, with drugs such as clarithromycin, fluvoxamine, diltiazem and other inhibitors of CYP3A4 can increase the concentration of the statin, predisposing to myopathy or even rhabdomyolysis.
Please consider these issues when preparing RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to email@example.com