Statins are the first-choice drugs in the cholesterol-lowering treatment for patients with coronary heart disease, cardiovascular risk factors, and cerebrovascular and peripheral vascular diseases. The fungal metabolite compounds (lovastatin, pravastatin, and simvastatin) are characterized by a hexahydronaphthalene ring with two major side chains: one chain is common to all compounds while the other is a methyl butyrate ester (lovastatin, pravastatin) or a dimethyl butyrate ester (simvastatin). The synthetic compounds (atorvastatin, rosuvastatin, and fluvastatin) have a heptanoic acid side chain that forms a structural analog of the HMG-CoA intermediate. The results of investigation (histopathologic examination, patch test, prick test, rechallenge test) carried out in a 79-year-old man affected by urticarial vasculitis from simvastatin (a side effect not reported in the literature) underline the possibility of administering a chemically different statin in subjects with cutaneous adverse statin reactions, using a synthetic statin in patients sensitized to a fungal metabolite compound the (or vice versa). In our patient the administration of atorvastatin was well tolerated.
Urticarial vasculitis from simvastatin: what is the alternative drug?
BELLINI, VERONICA;LISI, Paolo
2010
Abstract
Statins are the first-choice drugs in the cholesterol-lowering treatment for patients with coronary heart disease, cardiovascular risk factors, and cerebrovascular and peripheral vascular diseases. The fungal metabolite compounds (lovastatin, pravastatin, and simvastatin) are characterized by a hexahydronaphthalene ring with two major side chains: one chain is common to all compounds while the other is a methyl butyrate ester (lovastatin, pravastatin) or a dimethyl butyrate ester (simvastatin). The synthetic compounds (atorvastatin, rosuvastatin, and fluvastatin) have a heptanoic acid side chain that forms a structural analog of the HMG-CoA intermediate. The results of investigation (histopathologic examination, patch test, prick test, rechallenge test) carried out in a 79-year-old man affected by urticarial vasculitis from simvastatin (a side effect not reported in the literature) underline the possibility of administering a chemically different statin in subjects with cutaneous adverse statin reactions, using a synthetic statin in patients sensitized to a fungal metabolite compound the (or vice versa). In our patient the administration of atorvastatin was well tolerated.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.