Statins: Fluvastatin, simvastatin and atorvastatin are predominantly lipid-soluble, whereas pravastatin and rosuvastatin are predominantly water-soluble. Therefore, if a patient gets SEs on a lipid-soluble statin, it’s worth trying water-soluble.
Remember that the cut-offs for stopping are liver enzymes >3x ULN or CK >5x ULN. Check ALT at 3/12 & 12/12 after treatment, CK only if symptomatic.
PPIs: Splitting the dose & taking as a bd regime can sometimes work better in controlling symptoms than taking it once daily. They work best if administered 30 to 60 mins before the first meal of the day (if a split dose is given, take the second dose before the evening meal) as this means their action will coincide with the postprandial gastric cell stimulation.
Rebound hyperacidity is probably only a problem in patients who’ve been on the PPIs for >6/12. In these cases, a 50% dose reduction every week should be enough, stopping after 1 week on the lowest dose.
There is one study showing esomeprazole to be better than omeprazole in healing oesophagitis (Expert Rev Gastroenterol Hepatol 2012; 6: 533 – 44) but none showing it to be better in dyspepsia.
SSRIs: Monitor U&Es in patients over 80 or those with a history of hyponatraemia, due to the hyponatraemia risk.
(Prescriber 24(7), 5th April 2013, plus old article from BMJ 2010, 3rd April, pg 755)
A Spoonful Of Sugar 