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Senior Citizen Health & Medicine
Zocor, Simvastatin Found to Disrupt Sleep Due to Fat Soluble
Characteristic of Lipophilic Statins
Doesn't mean everyone on simvastatin will experience
worse sleep
 Nov. 7, 2007 – Although the experts continuously
tell senior citizens that sleep problems are not a normal part of aging,
many find it hard to believe when so many older people have trouble
sleeping. A least one answer may have emerged at the American Heart
Association’s Scientific Session – one type of statin, taken my millions
of seniors, simvastatin or brand name Zocor, has been found to disrupt sleep.
“The findings are significant because sleep
problems can affect quality of life and may have adverse health
consequences, such as promoting weight gain and insulin resistance,”
said Beatrice Golomb, M.D., lead author of the study.
She is an associate professor of medicine and
family and preventive medicine at the University of California at San
Diego School of Medicine.
In the largest study of its kind, researchers
compared two types of cholesterol-lowering drugs called statins -
simvastatin (Zocor), which is lipophilic (soluble in fats), and
pravastatin (Pravachol), which is hydrophilic (soluble in water).
Because simvastatin is fat soluble it can more
readily penetrate cell membranes and cross the blood brain barrier into
the brain. The brain controls sleep, and many of the brain’s nerve cells
are wrapped in a fatty insulating sheath called myelin.
“The results showed that simvastatin use was
associated with significantly worse sleep quality. A significantly
greater number of individuals taking simvastatin reported sleep problems
than those taking either pravastain or the placebo,” Golomb said.
| |
More About
Statins |
|
| |
|
Consumers Report Statin Reference |
|
Generic Name |
BrandName |
Generic? |
*Lipophilic? |
|
Atorvastatin |
Lipitor |
No |
Less |
|
Fluvastatin |
Lescol, Lescol XL |
No |
Less |
|
Lovastatin |
Mevacor, Altoprev |
Yes |
Most |
|
Pravastatin |
Pravachol |
Yes |
Less |
|
Simvastatin |
Zocor |
Yes |
Most |
|
Simvastatin/Ezetimibe |
Vytorin |
No |
|
|
Rosuvastatin |
Crestor |
No |
Less |
“Other
cholesterol-lowering medicines are available, but they are less
widely prescribed. Talk to your doctor about whether these other
medicines – such as niacin (Niacor) or ezetimibe (Zetia) – may
be useful for you, possibly in combination with a statin.” -
Report on Statins by Consumer Reports, Feb. 2007 –
Click for pdf
*Lipophilic classification added from Pharmacy Times (Click
for more) and read below.
“Scientists
like to describe medical compounds based on their hydrophilic or
lipophilic nature. These parameters play a very significant role
in the pharmacodynamic and pharmacokinetic behavior of every
medication. In terms of lipophilic nature, lovastatin and
simvastatin are the most lipophilic, followed by atorvastatin,
fluvastatin, and pravastatin. Rosuvastatin is a relatively new
statin, having a polar methane sulfonamide group, and it can be
placed between fluvastatin and pravastatin.” – Pharmacy Times,
March 2005 (Click
for more)
“Statins
currently available in the U.S.include:
Atorvastatin
(Lipitor®)
Fluvastatin
(Lescol®)
Lovastatin (Mevacor®,
Altoprev™)
Pravastatin
(Pravachol®)
Rosuvastatin
Calcium (Crestor®)
Simvastatin
(Zocor®)
Statins are
also found in the combination medications Advicor® (lovastatin +
niacin), Caduet® (atorvastatin + amlodipine), and Vytorin™ (simvastatin
+ ezetimibe). – American Heart Association (click
for more)
“Do
cholesterol-lowering medicines have any side effects?
Like all
medicines, these drugs can cause side effects. However, the side
effects usually are not severe and are not experienced very
often.
Common side effects of cholesterol-lowering drugs include the
following:
Diarrhea or
constipation
Abdominal
pain, cramps, bloating or gas
Nausea
and/or vomiting
Headache
Drowsiness
or dizziness
Muscle aches
or weakness
Flushing
(skin turning red and warm)
Sleep
problems
American
Academy of Family Physicians (Click
for more) |
|
“On average, the lipophilic statin had a greater
adverse effect on sleep quality.”
In past studies and case reports, some people on
statins reported having insomnia or nightmares.
“Several small studies were done early on,
including those focused on lipophilic versus hydrophilic statins,”
Golomb said. “Most (researchers) didn’t see a difference in sleep, but
they had short durations of follow-up and enrolled just a handful of
people — often fewer than 20, which was not enough to see a difference
unless it was very large.
“One of these studies did report a significant
difference between pravastatin and simvastatin. But without more and
bigger studies, an effect was not considered to be established.”
In this study, researchers tested 1,016 healthy
adult men and women for six months in a randomized, double-blind,
placebo-controlled trial using simvastatin, given at 20 milligrams (mg),
pravastatin at 40 mg, or a placebo.
They assessed outcomes with the
Leeds sleep scale, a visual analog scale of sleep quality, and a rating
scale of sleep problems. Both scales were measured before and during
treatment.
“Those who reported developing much worse sleep on
study medication also showed a significant adverse change in aggression
scores compared to others,” Golomb said
“We should also point out that although the average
effect on sleep was detrimental on simvastatin, this does not mean that
everyone on simvastatin will experience worse sleep.”
Researchers did not include patients with heart
disease or diabetes due to concerns about assigning these people to
placebos.
“Patients taking simvastatin who are having sleep
problems should consult with their doctor,” Golomb said. “Sleep
deprivation is a major problem in a minor number of people.”
Editor’s Notes:
The National Heart, Lung, and Blood Institute of
the National Institutes of Health funded the study.
Co-authors are Edwin K. Kwon, B.A.; Michael H.
Criqui, M.D., M.P.H.; and Joel E. Dimsdale, M.D.
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