Development of tachyphylaxis among patients taking HMG CoA reductase inhibitors

The purpose of this study was to determine if long-term use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) resulted in tachyphylaxis (a decreasing response to a physiologically active agent). To determine this, the charts of 254 patients treated with statins from the years 1996 to 1998 were retrospectively reviewed. During treatment, the low-density lipoprotein (LDL) cholesterol levels of patients were followed for a minimum of 300 days. To characterize LDL cholesterol changes during statin therapy, linear and nonlinear kinetic models were generated. Tachyphylaxis, defined as a positive slope of LDL cholesterol over time, after maximum LDL cholesterol reduction, was identified in patients treated with atorvastatin at exposure doses of 10 or 20 mg/day. All other statins, at all doses reviewed, showed no [corrected] evidence of tachyphylaxis. LDL cholesterol tachyphylaxis appeared to be a unique response to prolonged use of long half-life atorvastatin therapy at exposure dosages.