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Table 1 Guideline for lipid management & conversion to formulary statin

From: A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients

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.
  1. *P3 includes alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin