Rash from Statin

[MdBrndPhrmcst]

Hey fellow pharmacists I'd like your input on this...

Pt "X" recently started simvastatin 40mg. Pt immediately develops a rash/hives which persist over 2 weeks. No muscle pain/cramping or weakness. Upon d/c of simvastatin rash/hives stop. MD asks pharmacist for lipid lowering rec. Should pharmacist reccomend trial of another statin? or go to another lipid lowering med with a different MOA?

I know pts who have myalgias on one statin often don't with another. You think this is also the case with a rash? I couldn't find any documentation of a cross reactivity between statins for rash.

anyways I wanted to see what other people's thoughts were....

My thought is if you can get a pt on a statin that's great (due to there multifold affects for the pts in addition to lipid lowering.) I'm thinking trial of diff statins until you run out of options. And if that doesn't work then go to another class of medications....

Thanks in advance!

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[patmcd]

If your going to try another statin it needs to be an in office trial. Depending on how much lowering you looking to get, I'd consider alternative therapy first. But if you need a lot of lowering then you don't have many other choices.
A quick pubmed search didn't yield any info and Mircomedex doesn't pop up a warning for allergy cross-reactivity.

 

[janeno]

It depend what the levels of LDL, TG, HDL, TC are. If LDL is really above the goal, I would try a different statin. If LDL is just a little above the goal but other factors are high (or HDL is low) - I would look at different meds.

 

[MdBrndPhrmcst]

If your going to try another statin it needs to be an in office trial. Depending on how much lowering you looking to get, I'd consider alternative therapy first. But if you need a lot of lowering then you don't have many other choices.
A quick pubmed search didn't yield any info and Mircomedex doesn't pop up a warning for allergy cross-reactivity.

thanks for your input..

I don't know about an in office trial. I think ideally that is a great idea.. but practically speaking I don't think a pt is going to be down with staying in office for a few hours to see if the rash/hives come back. I know practicioners will send pts home on a new statin even though they had muscle pain to a previous one... hell sometimes in past notes i've seen doctors do it when the pt had an elevated cpk to one statin and started them on another. I still feel that regardless of ldl level.. a diff statin should be tried since you getting the anti-inflamtory and plaque stabilizing effects as well...

 

[Aznfarmerboi]

Hey fellow pharmacists I'd like your input on this...

Pt "X" recently started simvastatin 40mg. Pt immediately develops a rash/hives which persist over 2 weeks. No muscle pain/cramping or weakness. Upon d/c of simvastatin rash/hives stop. MD asks pharmacist for lipid lowering rec. Should pharmacist reccomend trial of another statin? or go to another lipid lowering med with a different MOA?

I know pts who have myalgias on one statin often don't with another. You think this is also the case with a rash? I couldn't find any documentation of a cross reactivity between statins for rash.

anyways I wanted to see what other people's thoughts were....

My thought is if you can get a pt on a statin that's great (due to there multifold affects for the pts in addition to lipid lowering.) I'm thinking trial of diff statins until you run out of options. And if that doesn't work then go to another class of medications....

Thanks in advance!

It is hard to say. For one thing, I suspect that this is an idosyncratic reaction and thus there can be a rechallenge with another statin. Idosyncratic reactions usually happens immediately as opposed to allergic reactions that usually take ~5 days for stimulation of immune system.

 

[Aznfarmerboi]

Another thing to consider is that most allergic reactions even though allergic reactions are barely studied besides penicillin is that it may be the result of one of the metabolites of the statin. It may be one of those insignificant metabolites of the statin that causes the reaction as opposed to the ones that are significant.

If it is an allergic reaction also, similar chemical structures will cause more immunogenicity versus different chemical structures (side chains).

 

[codep1nk]

IMHO =]...if your patient needs the statin purely for lipid lowering effects...there are still other drugs that he can benefit from so why risk another rxn.

However, if he has other conditions where he can benefit further aside from just lipid lowering effects (ie post MI), then I believe it's worth the risk. The rxn wasn't anaphylactic...so if patient agrees and knowing the risk of breaking out in another rash...go for it.

 

[WhiteSnows]

You can find these information on www.pubmed.com

 

[Pharmavixen]

The rash could have occurred for other reasons, just as myalgia on statins also usually occurs for other reasons.

I don't know if this is helpful, but simvastatin, lovastatin, and pravastatin are derived from fungi, and fluvastatin, atorvastatin, and rosuvastatin are entirely synthetic.

And atorvastatin and rosuvastatin are more potent.