Atorvastatin in hospitals

[Sparda29]

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Now that Lipitor (Atorvastatin) has gone generic, do you guys think there's gonna be an immediate shift on the formularies to make this the premier drug, now that we've seen how ****ty Simvastatin is?

I'm tired of making calls all day to the doctors to tell their they gotta change their Simvastatin dose or d/c is because the patient is on Diltiazem, Amlodipine, Amiodarone, etc.

 

[Trankuil]

I can see it happening over the next year or so, but not immediately. just an opinion though.

 

[PumpkinSmasher]

Now that Lipitor (Atorvastatin) has gone generic, do you guys think there's gonna be an immediate shift on the formularies to make this the premier drug, now that we've seen how ****ty Simvastatin is?

I'm tired of making calls all day to the doctors to tell their they gotta change their Simvastatin dose or d/c is because the patient is on Diltiazem, Amlodipine, Amiodarone, etc.

We just discussed this in P&T couple weeks ago...we are thinking we will switch to atorvastatin in the next year or so...

 

[CUninja]

Just asking for people's opinions, but do you think that in the future that the restrictions currently placed on simvastatin will be class-wide or that it will be for selected statins only?

I myself wouldn't be shocked to see this be a class-wide restriction in the future, even though some statins are worse than others when it comes to myopathies. One could make a good case that the FDA was waiting for Lipitor to go generic to put restrictions on it, and that the other statins are not used nearly to the degree that the previously mentioned two are. (Couldn't find a comparison by number of scripts to back that up though.) I've actually seen a preferential switch to pravastatin over atorvastatin in my area, even taking into account the fact that Lipitor is going generic today.

 

[tungsten87]

Now that Lipitor (Atorvastatin) has gone generic, do you guys think there's gonna be an immediate shift on the formularies to make this the premier drug, now that we've seen how ****ty Simvastatin is?

I'm tired of making calls all day to the doctors to tell their they gotta change their Simvastatin dose or d/c is because the patient is on Diltiazem, Amlodipine, Amiodarone, etc.

Atorvastatin is a 3A4 substrate as well...

 

[ValeRx]

Atorvastatin is a 3A4 substrate as well...

That's why you go pravastatin to avoid the entire hepatic enzyme system altogether!

 

[quantumleap]

That's why you go pravastatin to avoid the entire hepatic enzyme system altogether!

I think i'd prefer rosuvastatin because not only is it more potent but, like pravastatin, is hydrophilic and is unable to distribute as easily into muscle and cause symptoms of myalgia.

 

[deleted205891]

They all have their uses
Rosuvastatin: no CYP3A4 interactions
Atorvastatin: no interaction with warfarin
Fluvastatin: no interaction with cyclosporine

 

[rph3664]

Hang onto your seats, people! The hospital where I work uses a lot of lovastatin! 😱 That's what the main doctors who admit patients here use.

 

[ValeRx]

I think i'd prefer rosuvastatin because not only is it more potent but, like pravastatin, is hydrophilic and is unable to distribute as easily into muscle and cause symptoms of myalgia.

Indeed. I prefer Crestor as well but I thought we were only talking generics here.

 

[ValeRx]

Hang onto your seats, people! The hospital where I work uses a lot of lovastatin! 😱 That's what the main doctors who admit patients here use.

Lol. Why not just give everyone red yeast rice!

 

[Ackj]

Lol. Why not just give everyone red yeast rice!

Because Baycol has better data.

 

[rph3664]

Because Baycol has better data.

Baycol was pulled off the market when I was still in retail, and that's been almost 10 years.

When I graduated in 1994, I got a job at a mail order place, and I could pick up a vial of Mevacor 20mg #90 (and also Premarin 0.625mg #90) and tell you what was in it without looking at the label or contents; those vials had a certain "feel" and I had handled them so many times, I knew what they were (but of course checked them anyway).

 

[Praziquantel86]

We use rosuvastatin and pravastatin. I think some institutions might switch, but it will be very interesting to see what Astra-Zeneca does with the pricing of Crestor to stay competitive.

 

[ValeRx]

We use rosuvastatin and pravastatin. I think some institutions might switch, but it will be very interesting to see what Astra-Zeneca does with the pricing of Crestor to stay competitive.

Pfizer already has that website to send people $4 copay cards to make sure they still buy brand Lipitor and not the new generic whenever it becomes available.

 

[iFarm]

The Ranbaxy and Watson generics will be the only competitors to branded Lipitor for six months, after which a number of other copycats may enter the market.

the cost of the Lipitor generics will likely be 20 percent to 30 percent lower than the original price of Lipitor during the first six months, and fall dramatically afterward.

http://www.chicagotribune.com/busin...g-goes-generic-today-20111130,0,5910429.story

 

[CUpharmD2013]

The Ranbaxy and Watson generics will be the only competitors to branded Lipitor for six months, after which a number of other copycats may enter the market.

the cost of the Lipitor generics will likely be 20 percent to 30 percent lower than the original price of Lipitor during the first six months, and fall dramatically afterward.

http://www.chicagotribune.com/busin...g-goes-generic-today-20111130,0,5910429.story

And the Watson generic is being made by Pfizer.

 

[Ackj]

And the Watson generic is being made by Pfizer.

Just like olanzapine is still made by Lilly, so it's basically still Zyprexa. Not a bad idea for the original company.

 

[Quiksilver]

I think i'd prefer rosuvastatin because not only is it more potent but, like pravastatin, is hydrophilic and is unable to distribute as easily into muscle and cause symptoms of myalgia.

This.

Crestor is formulary where I am at.

Its too bad Crestor is a better drug then Lipitor.

 

[Pharmavixen]

For our formulary, it's Lipitor and Crestor. Like someone else mentioned, atorvastatin is also a substrate for 3A4, and I prefer the dr prescribes Crestor if the pt is also on, say, amlodipine.

BTW, can I inquire what folks pay for these? We've had generic atorvastatin for a while, and I pay around $6 for 100 of the 10 mg and $20 for 100 of the 40 mg.

 

[PharMed2016]

Now that Lipitor (Atorvastatin) has gone generic, do you guys think there's gonna be an immediate shift on the formularies to make this the premier drug, now that we've seen how ****ty Simvastatin is?

I'm tired of making calls all day to the doctors to tell their they gotta change their Simvastatin dose or d/c is because the patient is on Diltiazem, Amlodipine, Amiodarone, etc.

Probably not since prices will not drop from another 6 months or so. There are only two generic manufacturers out currently with market exclusivity for the next 6 months which will only bring the price down a little bit.

As for how ****ty simvastatin is... I don't agree with you on that point. It's true that atorvastatin lowers LDL more so than simvastatin but remember that that is a surrogate endpoint and a poor one at that. There are no clinical trials that have found that the difference in ability between the two statins to lower LDL actually lowers mortality.



If we want to pour over clinical data... there was a recent article in NEJM between rosuvastatin and atorvastatin. It was a huge negative trial for AstraZenaca as no statistical difference was found for the primary endpoint of PAV between these two different statins. Just some food for thought.

 

[PharMed2016]

For our formulary, it's Lipitor and Crestor. Like someone else mentioned, atorvastatin is also a substrate for 3A4, and I prefer the dr prescribes Crestor if the pt is also on, say, amlodipine.

BTW, can I inquire what folks pay for these? We've had generic atorvastatin for a while, and I pay around $6 for 100 of the 10 mg and $20 for 100 of the 40 mg.

Depending on their co-pay for their insurance would be my best guess. Have you heard about the whole backdoor deal with Lipitor?

 

[Pharmavixen]

Depending on their co-pay for their insurance would be my best guess. Have you heard about the whole backdoor deal with Lipitor?

I mean, what you pay from the wholesaler. And I hadn't heard about the backdoor deal with Lipitor, but just googled to an interesting Forbes article. It doesn't apply where I practice (Canada).

 

[xiphoid2010]

Now that Lipitor (Atorvastatin) has gone generic, do you guys think there's gonna be an immediate shift on the formularies to make this the premier drug, now that we've seen how ****ty Simvastatin is?

Since patients are on various statins outpatient for a ton of different reasons, due to lipophilicity/myalgia, ldl goal, interactions, insurance, etc, most patients are kept on the same statin when they get admitted (unless there is a new reason to change it). Which statin is formulary mainly affect a small % of patients starting statin for first time.