title: [Specific considerations on the prescription and therapeutic interchange of statins].
abstract: OBJECTIVE
  The pharmaceutical industry currently offers six different statins in Spain and there is one more soon to be available. Choosing the most appropriate drug and dose is determined by the therapeutic target (reduction in LDL-C levels). Statin doses that decrease LDL-C at the same percentage are considered equivalent. Evaluating the pharmacokinetic characteristics of each statin can be useful when setting selection criteria, helping to determine which statin may be more appropriate for a patient based on their individual characteristics and on the other co-administered drugs.
  
  
  METHODS
  We reviewed the pharmacokinetics properties of each statin and its possible involvement in drug interactions.
  
  
  RESULTS
  CYP3A4 was responsible for the metabolism of lovastatin, simvastatin and atorvastatin; fluvastatin depends on CYP2C9; P-glycoprotein is responsible for decreased atorvastatin, pravastatin, simvastatin and lovastatin concentrations. The OATPA1B1 transporter involved in all statins' access to the hepatocyte, except for fluvastatin, is essential for rosuvastatin and pravastatin. These circumstances cause those drugs inhibiting or inducing isoenzymes or transporters' activity not to have the same effect on the different statins.
  
  
  CONCLUSIONS
  The pharmacokinetics is important when choosing the best statin and could be a limitation in the use of interchange therapeutic programmes when other drugs are present.
authors.affiliation: Servicio de Farmacia, Hospital Universitario Lucus Augusti, Lugo, España. antonio.garcia.sabina@sergas.es
authors.forename: A
authors.initials: A
authors.lastname: García-Sabina
authors.forename: J
authors.initials: J
authors.lastname: Gulín-Dávila
authors.forename: P
authors.initials: P
authors.lastname: Sempere-Serrano
authors.forename: C
authors.initials: C
authors.lastname: González-Juanatey
authors.forename: R
authors.initials: R
authors.lastname: Martínez-Pacheco
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism; D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics / Q000378:metabolism; D065729:Cytochrome P-450 CYP2C9; D004345:Drug Industry; D004347:Drug Interactions; D011307:Drug Prescriptions; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008099:Liver / Q000378:metabolism; D027381:Liver-Specific Organic Anion Transporter 1; D027361:Organic Anion Transporters / Q000378:metabolism; D013030:Spain
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D027381:Liver-Specific Organic Anion Transporter 1; D027361:Organic Anion Transporters; C503999:SLCO1B1 protein, human; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; C422408:CYP3A43 protein, human