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Comment and Response |

Why Physicians Favored Lipitor Over Simvastatin—Reply

Brian K. Alldredge, PharmD1; Steven R. Kayser, PharmD1
[+] Author Affiliations
1Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco
JAMA Intern Med. 2013;173(15):1473. doi:10.1001/jamainternmed.2013.7701.
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In Reply Dr Keller correctly cites the Food and Drug Administration safety communication regarding the 80-mg dose of simvastatin as a factor that may have influenced the prescribing of that agent relative to Lipitor (atorvastatin calcium; Pfizer Inc). The June 8, 2011, safety communication was preceded by an earlier notice on March 19, 2010, regarding the possibility that 80-mg simvastatin was associated with an increased risk of muscle injury relative to other drugs in the statin class. However, in the years leading up to these safety communications during which less-expensive generic simvastatin products were available (ie, 2007-2009), Lipitor was not only the most commonly prescribed statin, surpassing generic simvastatin, but also the most commonly prescribed drug, surpassing all other prescription drugs.1

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August 12, 2013
David L. Keller, MD
1Providence Medical Group, Torrance, California
JAMA Intern Med. 2013;173(15):1473. doi:10.1001/jamainternmed.2013.7747.
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Physicians anticipated the FDA warnings
Posted on August 24, 2013
D Keller
PMG
Conflict of Interest: None Declared
Any physician who practiced clinical medicine and kept informed knew that simvastatin was inferior to Lipitor in terms of both efficacy and safety. Data was widely available prior to the first FDA warning which established Lipitor as the superior statin. Many patients refused to take simvastatin 80 mg due to myalgias which disappeared when switched to Lipitor, along with reductions in their CPK levels. It is time to stop criticizing doctors for wanting to prescribe the best possible medication for our patients. Many patients have the resources and the desire to purchase the medication which is best for them.
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