Table 3.

Lipid-lowering Medication Dose Adjustments for Reduced Kidney Function

GFR (ml/min/1.73 m2)
Agent	60 to 90	15 to 59	<15	Notes
Statins*
Atorvastatin	No	No	No
Fluvastatin	No	↓ to 50%	↓ to 50%	Decrease dosage by half at GFR < 30
Lovastatin	No	↓ to 50%	↓ to 50%	Decrease dosage by half at GFR < 30
Pravastatin	No	No	No	Starting dose of 10 mg/day recommended for GFR < 60
Rosuvastatin	No	↓	↓	Decrease to a maximum of 10 mg/day at GFR < 30; recommended starting dose is 5 mg/day
Simvastatin	?	?	?	Start at 5 mg/day in patients with GFR < 10
Nicotinic acid	No	No	↓ to 50%	May worsen glycemic control and cause orthostasis, hyperuricemia, and flushing
Bile acid sequestrant
Cholestyramine	No	No	No	Not absorbed
Cholestipol	No	No	No	Not absorbed
Colesevelam	No	No	No	Not absorbed
Fibrates*
Clofibrate	↓ to 50%	↓ to 25%	Avoid	May increase serum creatinine†
Fenofibrate	↓ to 50%	↓ to 25%	Avoid	May increase serum creatinine†
Gemfibrozil	No	No	No	Likely no effect on serum creatinine

^*Because of increased risk of myositis and rhabdomyolysis, statin therapy in conjunction with a fibrate should be avoided in patients with chronic kidney disease.

^†The increase in levels of serum creatinine seen with most fibrates has not been appreciated with gemfibrozil.

GFR, glomerular filtration rate in ml/min/1.73 m²;

Reproduced with permission from NKF K/DOQI guidelines on treating dyslipidemia.³