From the Guidelines
Rosuvastatin and simvastatin are the statins that require caution and dose adjustment in Asian patients, particularly those of East Asian descent, due to higher systemic exposure and plasma concentrations. When considering statin therapy for Asian patients, it is essential to take into account the potential for increased risk of myopathy and other adverse effects due to genetic variations in drug metabolism and transport 1. The primary concern is with rosuvastatin, which requires a lower starting dose of 5mg in Asian patients compared to the standard 10mg dose in non-Asian patients 1. Other statins like atorvastatin and pravastatin may also require careful dosing, but the evidence for mandatory dose adjustments is strongest for rosuvastatin 1. Some key points to consider when prescribing statins to Asian patients include:
- Higher rosuvastatin plasma levels are seen in Japanese, Chinese, Malay, and Asian Indians compared to whites 1
- The FDA recommends a lower starting dose of rosuvastatin in Asians 1
- Clinicians should take Asian race into account when prescribing the dose of rosuvastatin and consider using other statins preferentially over simvastatin in adults of East Asian descent 1
- Healthcare providers should monitor Asian patients on statins closely for side effects, particularly muscle pain or weakness, and consider pharmacogenetic factors when prescribing these medications 1.
From the FDA Drug Label
Asian patients may be at higher risk for myopathy.
CONTRAINDICATIONS Acute liver failure or decompensated cirrhosis. Hypersensitivity to rosuvastatin or any excipients in rosuvastatin tablets
The FDA drug label does not answer the question.
From the Research
Statin Contraindications in Asian Patients
- There is no direct evidence from the provided studies that specifically contraindicates certain statins in Asian patients.
- However, the studies suggest that Asian patients may be more susceptible to statin-induced adverse effects, such as myopathy, due to differences in drug metabolism and thyroid hormone status 2.
- A study comparing the safety of different statins in an Asian population found that pitavastatin may be associated with a lower risk of safety events, including hepatitis and new-onset diabetes mellitus, compared to atorvastatin and rosuvastatin 3.
- Another study found that simvastatin was effective and well-tolerated in Asian patients with coronary heart disease, with a low incidence of adverse experiences 4, 5.
- The choice of statin and dosage should be individualized based on patient characteristics, medical history, and concomitant medications, rather than a blanket contraindication in Asian patients.
- It is essential to monitor patients for potential adverse effects and adjust treatment accordingly, taking into account factors such as thyroid hormone status and concomitant medication use 2, 6.