By Duane Graveline, M.D., M.P.H.
In today's world we all must look to get the biggest bang for our buck and in the world of statin drugs, the biggest bang is with generics. As a retired family doctor who was in practice for 23 years, I have never been impressed by the self-serving drug company warnings to buy brand name products.
After emerging from my 10 year tour in the regular Air Force in what is one of the very best health care delivery systems, it was a shock to enter civilian practice and be constantly faced with the real costs of health care delivery and such critically important issues as the patient's ability to pay.
I found myself constantly juggling my concepts of best medicine with what was best for the patient. I learned quickly that generics were a bargain and, despite constant pressure from drug reps, quickly structured my own office formulary of medicines prescribed to be generic whenever possible.
In so doing I was being cost conscious for the good of the patient. I have never felt I was sacrificing quality and even today I demand generics from my own doctors.
Statin drugs all work the same way - to inhibit the reductase step in the mevalonate pathway, that critical micro-factory in every cell in the body, responsible for among other things cholesterol synthesis.
Merck was the first drug company to jump on this reductase step idea because of its relative simplicity, biochemically speaking, to be blocked, and so lovastatin was born.
The brand name for this was Mevacor. A few years later we had the generic named simvastatin with the brand name Zocor. Then came the generic named pravastatin, with the brand name Pravachol, the generic named fluvastatin with the brand name Lescol and the generic named cerivastatin with the brand name Baycol - subsequently withdrawn due to serious side effects.
Brand name Lipitor was next with the generic name atorvastatin, followed by the even more powerful generic named rosuvastatin, with brand name, Crestor. These are the primary statins in use currently in the United States.
Three of these statins now are available in generic form:
1) Lovastatin ( Mevacor, Altocor, Altoprev ). Lovastatin has been available as a generic statin drug since 2001.
2) Pravastatin ( Pravachol, Lipostat, Selektine ). Pravastatin has been available as a generic drug since 2006.
3) Simvastatin ( Zocor, Lipex, Simcard, Simlup ). Simvastatin has been available as a generic since 2006.
More of the branded statins are due to come off-patent in the coming years opening the door for more generics to enter. Lipitor is scheduled to be available in generic form - atorvastatin - by the end of 2011. Expect generic statin drugs to continue to rapidly expand their market share in the years ahead.
With increasing research evidence of cholesterol irrelevance to the process of atherosclerosis, the early drug company boasts of 40-50% reduction of serum cholesterol no longer have the same attraction they once had.
Now that we know this is a marker of mevalonate blockade, the 50% decrease in cholesterol now means 50% reduction in CoQ10, dolichols, selenoprotein and normal phosphorylation. Therefore, this high percentage cholesterol reduction rate should be taken as much more of a warning than something to boast about.
In my opinion any doctor can practice effective medicine with currently available generic statins. Pravastatin can be considered to be somewhat weaker than lovastatin and lovastatin is somewhat weaker than simvastatin, so a doctor has the full range of effectiveness.
Lipitor is not significantly more powerful than simvastatin and in my judgment, Crestor is way too powerful, so from the viewpoint of both cholesterol lowering and anti-inflammatory effects, there is already a wide choice among the generic statins.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Updated July 2011