Table 17.
Lipid-lowering medication dose adjustments for reduced kidney function.
| Agents | Dose adjustment according to GFR (ml/min/1.73 m2) |
Notes | ||
|---|---|---|---|---|
| 60 to 90 | 15 to 59 | <15 | ||
| Statinsa | ||||
| Atorvastatin | None | None | None | |
| Fluvastatin | None | ↓ to 50% | ↓ to 50% | Decrease dosage by half at GFR < 30 |
| Lovastatin | None | ↓ to 50% | ↓ to 50% | Decrease dosage by half at GFR < 30 |
| Pravastatin | None | None | None | Starting dose of 10 mg/day recommended for GFR < 60 |
| Rosuvastatin | None | ↓ | ↓ | 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 | None | None | ↓ to 50% | May worsen glycemic control and cause orthostasis, hyperuricemia, and flushing |
| Bile acid sequestrant | ||||
| Cholestyramine | None | None | None | Not systemically absorbed |
| Cholestipol | None | None | None | Not systemically absorbed |
| Colesevelam | None | None | None | Not systemically absorbed |
| Fibratesa | ||||
| Clofibrate | ↓ to 50% | ↓ to 25% | Avoid | May increase serum creatinineb ↑ risk of myopathy |
| Fenofibrate | ↓ to 50% | ↓ to 25% | Avoid | May increase serum creatinineb ↑ risk of myopathy |
| Gemfibrozil | None | None | Avoid | Likely no effect on serum creatinine ↑ risk of myopathy |
GFR, glomerular filtration rate in ml/min/1.73 m2.
a
Because of increased risk of myositis and rhabdomyolysis, statin therapy in conjunction with a fibrate should be avoided in patients with chronic kidney disease.
b
The increase in levels of serum creatinine seen with most fibrates has not been appreciated with gemfibrozil.