Table 1 Guideline for lipid management & conversion to formulary statin

a. Order lipid panel and P3* every 4 months if patient is currently on cholesterol lowering medication.

b. If patient is at goal without drug therapy, draw lipid panel and P3 yearly.

c. Modify/Initiate patient's therapy per the following guideline:

If patient is on:

Action:

Cyclosporine

Refer to nephrologist

Gemfibrozil

Refer to nephrologist

If triglycerides >200

Refer to nephrologist

If patient's current cholesterol medication is:

None, and LDL>100, no contraindications

Begin Simvastatin 20 mg (1/2 of 40 mg tablet)

Provide pharmacy counseling, drug literature, dietary consult if needed.

Pravastatin, fluvastatin, lovastatin, simvastatin 5 mg, or simvastatin 10 mg qd

Convert to Simvastatin 20 mg qd (1/2 of 40 mg tablet)

Atorvastatin 20 mg qd

Convert to Simvastatin 40 mg qd

Atorvastatin 40 mg qd

Convert to Simvastatin 80 mg qd

Atorvastatin 80 mg qd

Continue Atorvastatin 80 mg qd

d. Draw P3 and lipid panel 8 weeks after changing or initiating therapy.

If liver enzymes are >3 times upper limit of normal

Refer to nephrologist.

Hold Statin.

If patient complains of muscle aches or weakness

Refer to nephrologist.

Draw CPK.

e. If LDL>100 after 8 weeks, adjust dosing according to the following guideline:

If current dose is Simvastatin 20 mg qd

Increase to Simvastatin 40 mg qd

If current dose is Simvastatin 40 mg qd

Increase to Simvastatin 80 mg qd

If current dose is Simvastatin 80 mg qd

Change to Atorvastatin 80 mg qd

f. Repeat steps d. and e. until patient reaches LDL goal or is taking Atorvastatin 80 mg

g. Draw P3 and lipid panel 8 weeks after initiating Atorvastatin 80 mg. If patient still not at LDL goal, refer to nephrologist.