Well, just because nobody in the group has "seen" a case of rhabdo doesn't mean they weren't out there.  Maybe they were "lost to follow-up", which are often the ones with adverse events.  The data is the data and there are understandable physiological mechanisms behind the interactions. 

We are running EMR screens for all patients and advising them to come in for additional consulation, probably to be switched to Crestor, if affordable, and otherwise Lipitor, with the generic version upcoming. 

Of course, confusion and adherence problems are a consideration but this is actually a sound recommendation, in my view. 

Our formulary statin is Simvastatin.  We limited the dose to 40mg in March 2010, as well as the drug interaction dosing limitations.

We maintained Lipitor 80mg for post ACS patients, as well as Crestor 40mg on our formulary.

Some cardiologists are frustrated with the simvastatin labeling changes because in practice we very rarely see rhabdomyolysis cases, but from a legal standpoint, are we sitting ducks?

The recommendation on the table is to switch to pravastatin as statin workhorse at our hospital, as well as maintain Lipitor 80mg and Crestor 40mg.

Thank you John.  I see patients with significant muscle pain and weakness to the point of distraction!  I also perform acupuncture and see a significant number of elder elders (80yrs+) on high dose statins and this has concerned me for awhile.  Thanks for the direction for the literaterature to show their physicians!

I'm a pharmacist with Walmart and I have been absolutely shocked to see the number of patients on Simvastatin 80 mg.  I think when you work in areas serving the middle to upper class you tend to see the more expensive statins being utilized, but with the turning economy, more and more people are being placed on Simvastatin, quite often at the highest doses.  

I've worked as a clinical pharmacist in hospitals for years and  volunteer at a local clinic for the poor.  In these settings, I have seen documented cases of rhabdo.  It is rare, but important and quite frightening to the patient.  

My approach to this new information has been to review rhabdo with every patient on Simvastatin 80 mg coming in for a refill/new Rx.  I call/fax the doctor to give them a heads up about the new information from the FDA in case they've missed it and as a gentle reminder that they have a patient on this high dose.  I also provide the patient with that information.  Additionally, I'm making a TON of recommendations on dose adjustments in light of the FDA alert for CCBs, gemfibrozil, etc. 

You specifically mentioned concern about switching to alternative statins and I want to share with you that I am working with people highly concerned about their wallets.  They come to Walmart to save money, often because they are unemployed, etc.  

During this time, I have had private conversations with the customers, reviewed the information, explained that it is extremely rare, but potentially very serious and reviewed options with them.  I explain that Lipitor will likely be off patient within a few months and show them the FDA chart comparing doses of equivalent statins.  I find that customers really appreciate knowing that there ARE options, understanding the risks/benefits of those options and most of my patients have been willing to pay more money for a brand name drug for a few months for better safety.  I do agree that switching several times between drugs is not a good idea, so I've been pushing more for Lipitor.

Hope that helps.  I really enjoy your blog!  Thanks.