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  • Clinical Pharmacy Question

    Hi Everyone

    Today I got a prescription, for a man on 100mg of atorvastatin per day. I rang Pfizer who obviously make Lipitor, and spoke to the drug info department. They had some studies with Dr's using up to 160mg per day, but 100mg was off licence, and therefore they obviously didn't recommend it.

    Looking at the patients other drugs, he was taking: -

    Aspirin 75mg OD
    Atorvastatin 20mg 1 OD
    Atorvastatin 80mg 1 OD
    Bendrofluazide 2.5mg 1 OM
    Ezetimibe 10mg 1 OD
    Metformin 500mg 1 BD
    Ramipril 10mg 1 OD

    So he seemed to be taking plenty of cholesterol lowering drugs! I phoned the GP and he informed me that this gent had been taking the atorvastatin 100mg / Ezetimibe for five months, and his cholesterol level was still 7.2! The GP basically said he had run out of ideas and if I could come up with any alternative treatment plan, he would happily try it.

    What do others think? I have a couple of ideas, but would like to hear the opinions of other pharmacists if possible.

    Thanks
    Lively debate is encouraged but please respect the opinions and feelings of others.
    Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
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  • #2
    try rosuvastatin at a lower dose, couple of life-style changes etc
    his triglycerides might be high, as it appears he is a diabetic (metformin)
    and triglycerides tend to be a bit high in this group of patients , so maybe a fibrate might help

    very high doses of statins have been known to cause myopathy ....
    It's a tough one because we can only speculate as we don't have access to his blood tests etc
    Kemzo the pharmacist forumly known as kemzero

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    • #3
      kemzero

      I talked to a Dr the other day about this. He runs a private clinic and said he was a consultant. He suggested trying two statins at low doses, and seemed to think that would have the same synergistic effect as when for e.g. two blood pressure drugs are used at once. I am not sure this works with statins though, but will do a bit of research on this.

      I was also concerned about the possible problems of high statin doses, which is why I contacted the GP and put this post on here. I think the guy has had all the lifestyle change talks etc. Do you mean add Rosuvastatin as well as atorvastatin (at a lower dose), or instead of ? Do you think that if one statin doesn't work very well in an individual, changing to another one will give a better result?

      Thanks for your reply

      Admin
      Lively debate is encouraged but please respect the opinions and feelings of others.
      Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
      Thank you for contributing to this site.

      Comment


      • #4
        clinical pharmacy

        Not two statins for sure
        The school of thot is that all statins are the same ,but their potency differs according to strength, so if one is looking to lower total LDL the following analogy applies pravastatin 80mg=fluvastatin 80mg=simvastatin 40mg=atorvastatin 20mg =rosuvastain 10mg ( not directly equal but almost with LDL reductions being 36%,37%,41%,43% and 53% in the same order as outlined above).

        High doses of statins will lead to more side effects particularly myopathy..
        I don't think one can combine statins like BP lowering drugs ,as all statins work the same way , but BP lowering drugs could be thiazides :wink: ,angiotensin converting enzymes,calcium channel blockers etc and they work in different ways besides there is national guidance for the use of BP lowering drugs that support this,but I am yet to come across guidance that supports the use of two statins, statins + fibrates yes, but not 2 statins.
        Rosuvastatin is obviously the most potent of the bunch and lower doses could be used to achieve better results but unfortunately it is not the most cost-effective,simvastatin is ,and in this day and age of health economics ,simvastatin is the drug of choice ,but Simvastatin at 40mg will only achieve 41% LDL reduction compared to rosuvastatin at 10mg where 52% will be achieved.
        I hope I have in a roundabout way answered your question
        Kemzo the pharmacist forumly known as kemzero

        Comment


        • #5
          Kemzero

          You have put a good answer, and thanks for that. I already knew the two statins was a no no, and wonder what kind of "consultant" that guy was.
          Lively debate is encouraged but please respect the opinions and feelings of others.
          Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
          Thank you for contributing to this site.

          Comment

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