Lipitor Once weekly

[ohiopharmacist]

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I have come across few scripts for Lipitor 10mg once a week??
Whats the point? Am I missing something here?

 

[bacillus1]

I found this:
http://www.ncbi.nlm.nih.gov/pubmed/11978260

It appears that 20mg once a week did have some lipid-lowering effect. 10mg though? I don't know.

 

[NormalSaline]

I have come across few scripts for Lipitor 10mg once a week??
Whats the point? Am I missing something here?

They're trying to achieve some lipid lowering while avoiding myalgias in sensitive patients.

I found this:
http://www.ncbi.nlm.nih.gov/pubmed/11978260

It appears that 20mg once a week did have some lipid-lowering effect. 10mg though? I don't know.

Rosuva would be a better choice due to higher potency and lower lipophillicity.

 

[ohiopharmacist]

thanks but wow...n=24,the study exhibits some REAL power. The physician was upset that I even questioned him but whatever I filled it anyway.

 

[npage148]

thanks but wow...n=24,the study exhibits some REAL power. The physician was upset that I even questioned him but whatever I filled it anyway.

I give Drs a lot more leeway in what I'll fill is their misguided prescription is useless as opposed to potentially harmful. But 10mg qw is eh, try pravastatin first

 

[spacecowgirl]

I give Drs a lot more leeway in what I'll fill is their misguided prescription is useless as opposed to potentially harmful. But 10mg qw is eh, try pravastatin first

Who knows what they already tried. I look at QW or BIW dosing as the last resort before non-statin txs. I have had luck with CoQ10 and prava or fluva with a couple of ppl, although not getting them to LDL goal. I figure it's better to have some lowering, some pleiotropic effects rather than nothing, even if the LDL is not where it "should" be.

 

[PumpkinSmasher]

Have you guys seen some older physicians write for Prava 20mg BID? I have seen this a few times among older docs and they had nothing to say except, "it has worked in my patients before and is safe so just fill it!" lol

Only data I can find is from the original trial that got pravastatin approved years ago but the BID dosing arm didn't see any significant lipid lower effect.

Interesting, just curious what you folks have seen..

 

[Pharmavixen]

Have you guys seen some older physicians write for Prava 20mg BID? I have seen this a few times among older docs and they had nothing to say except, "it has worked in my patients before and is safe so just fill it!" lol

Yup, seen it. And I had the same result when I tried to get the dr to change it.

Another argument you can try on drs, other than efficacy, is the improved adherence you get from once-daily dosing. (Though if the efficacy argument doesn't work on them, adherence is probably also a no-go.)

Re the O/P: I'm assuming this is primary and not 2ndary prevention.

 

[Carboxide]

I wonder why they wouldn't try niacin or a bile acid sequestrant to lower the LDL before going to QW...

 

[spacecowgirl]

Who knows what they already tried. I look at QW or BIW dosing as the last resort before non-statin txs. I have had luck with CoQ10 and prava or fluva with a couple of ppl, although not getting them to LDL goal. I figure it's better to have some lowering, some pleiotropic effects rather than nothing, even if the LDL is not where it "should" be.

I wonder why they wouldn't try niacin or a bile acid sequestrant to lower the LDL before going to QW...

See my post above. There is more to preventing CV events than just LDL lowering. Case in point, ezetimibe.

 

[type b pharmD]

See my post above. There is more to preventing CV events than just LDL lowering. Case in point, ezetimibe.

ezetimibe haha what a scam

thats what we like to call 'massaging the numbers'

 

[spacecowgirl]

Have you guys seen some older physicians write for Prava 20mg BID? I have seen this a few times among older docs and they had nothing to say except, "it has worked in my patients before and is safe so just fill it!" lol

Only data I can find is from the original trial that got pravastatin approved years ago but the BID dosing arm didn't see any significant lipid lower effect.

Interesting, just curious what you folks have seen..

I'm of two minds in those sorts of situations. On the one hand, it makes no sense to dose a statin BID (other than fluva). If you are concerned about it not being a true QD med, use simva.

OTOH, if the patient tolerates it, it's cheap now and it's doing the job...it ain't broke.

Yup, seen it. And I had the same result when I tried to get the dr to change it.

Another argument you can try on drs, other than efficacy, is the improved adherence you get from once-daily dosing. (Though if the efficacy argument doesn't work on them, adherence is probably also a no-go.)

Re the O/P: I'm assuming this is primary and not 2ndary prevention.

Adherence would be the only argument, I would think. Is the patient refilling on time? If not, I would use that angle.

 

[spacecowgirl]

I wonder why they wouldn't try niacin or a bile acid sequestrant to lower the LDL before going to QW...

No primary prevention data for niacin, side effects not so fun, can raise glucose.

BAS - side effects not so fun, multiple daily dosing, cost, no data in women (not to say it doesn't work, but you know...)

 

[Clavulanic]

Whoa, isn't the half life of lipitor ~14 hours with it's action half life longer than that by a bit?
So after 1-2 days that lipitor wouldn't be having much of an effect at all.

I don't see why someone would be on this unless they have tried every other lipid lowering agent like others suggested (bile acid sequesterants, the other statins, niacin, etc...). Or perhaps their LDL is only a little elevated.

 

[Ackj]

I can't find it at the moment, but I read a study where patients who were on a normal dose of a statin for a while, and then were d/c'd still showed some improvements in mortality. Assumption was that it helped to clear out the past 50 years of plaque, so their body was in comparable shape to those who continued on the statins. Obviously it'd probably be better to stay on the drug, but it sort of gives some credit for the "something is better than nothing" dosing of QW.


Also, when I first saw the title, I thought this was going to be a crazy patent extender.

 

[NormalSaline]

Who knows what they already tried. I look at QW or BIW dosing as the last resort before non-statin txs. I have had luck with CoQ10 and prava or fluva with a couple of ppl, although not getting them to LDL goal. I figure it's better to have some lowering, some pleiotropic effects rather than nothing, even if the LDL is not where it "should" be.

coq10 is a scam.

 

[rxlea]

coq10 is a scam.

Who says?

 

[spacecowgirl]

coq10 is a scam.

Educate me, oh wise one.😀 (if your response is to read the clinical trials, I already know them, well).