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Comment & Response
August 12/26, 2013

Why Physicians Favored Lipitor Over Simvastatin—Reply

Author Affiliations
  • 1Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco
JAMA Intern Med. 2013;173(15):1473. doi:10.1001/jamainternmed.2013.7701

In Reply Dr Keller correctly cites the Food and Drug Administration safety communication regarding the 80-mg dose of simvastatin as a factor that may have influenced the prescribing of that agent relative to Lipitor (atorvastatin calcium; Pfizer Inc). The June 8, 2011, safety communication was preceded by an earlier notice on March 19, 2010, regarding the possibility that 80-mg simvastatin was associated with an increased risk of muscle injury relative to other drugs in the statin class. However, in the years leading up to these safety communications during which less-expensive generic simvastatin products were available (ie, 2007-2009), Lipitor was not only the most commonly prescribed statin, surpassing generic simvastatin, but also the most commonly prescribed drug, surpassing all other prescription drugs.1

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    1 Comment for this article
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    Physicians anticipated the FDA warnings
    D Keller | PMG
    Any physician who practiced clinical medicine and kept informed knew that simvastatin was inferior to Lipitor in terms of both efficacy and safety. Data was widely available prior to the first FDA warning which established Lipitor as the superior statin. Many patients refused to take simvastatin 80 mg due to myalgias which disappeared when switched to Lipitor, along with reductions in their CPK levels. It is time to stop criticizing doctors for wanting to prescribe the best possible medication for our patients. Many patients have the resources and the desire to purchase the medication which is best for them.
    CONFLICT OF INTEREST: None Reported
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