new cholesterol med--please help

[drjeni2b]

I was wondering if anyone had any thought about a new statin drug--Crestor--ie rosuvastatin calcium. My mom has been on Zocor with mild to no side effects, but her cholesterol is still running around 215 (ratio around 4). Her doc wants to put her on Crestor, but i have heard that crestor has worse side effects than other statins...any thoughts??

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[RavnShield]

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[johnd]

Umm...medication for 215? Its nuts. 215 is only 15 over borderline. Proper eating and exercise should lower it. Or is there something else to this story? I am curious as to what kind of doctor would resort to medication for a barely borderline level.

DrJen said 215 AFTER zocor. As far as I know the side effects of crestor are not worse than other statins but the incidence of serious myopathy may be higher. As long as she knows to see her doctor if she develops musle aches and follows up regularly she should be fine.

 

[drjeni2b]

Let me clarify a little bit...There is a history of hypertension, heart disease, and diabetes in the family. She herself suffers from osteoporosis and hypertension (although it has been controlled with Avapro for a while now). However, her lifestyle is very active including 5 workouts per week and more than 5 fruits/veggies per day. My thoughts are that this cholesterol issue is almost strictly a genetic thing..hopefully this clears up the situation a bit. thanks for the help!!

 

[CeLo]

Lipitor is better... but I work for Pfizer, so i might be biased

 

[doc05]

lipitor is better ... and I don't work for pfizer.

 

[Kalel]

Crestor actually is a stronger statin then lipitor, but besides a slight increase rhabdo and elevated LFT's over the other statins, it also carries the low risk of renal failure. Just as long as she's monitored and isn't taking too high of a dose, it should be fine. It sounds like they are having a difficult time lowering her cholesterol to therapeutic levels, so it is very appropriate to switch her from zocor to crestor. If she wants something that has been better studied, a high dose of lipitor may be an appropriate option as well.

 

[punjabiMD]

I thought that rosuvastatin had been banned?

 

[Boomer]

I was wondering if anyone had any thought about a new statin drug--Crestor--ie rosuvastatin calcium. My mom has been on Zocor with mild to no side effects, but her cholesterol is still running around 215 (ratio around 4). Her doc wants to put her on Crestor, but i have heard that crestor has worse side effects than other statins...any thoughts??

Add Zetia.

 

[Kalel]

zetia is one option, but most people would switch to a stronger statin first. The fewer meds a patient has to take, the better. Crestor was not taken off the market (although there are class action lawsuits meant to pad lawyer's income that may do that). Baychol was a statin which was taken off the market a few years ago thanks to all of the litigation. Crestor's release was delayed because the company was worried about litigation since it was scheduled to be released around the same time that Baychol was being recalled, plus the FDA was worried about it since it had the added renal failure side effect. I don't think that there's anything particularly wrong iwth it though, especially if you are taking low dosages, since most of the side effects that the FDA was concerned about were only occuring at high dosages.

 

[AJM]

As Kalel has said, both Lipitor and Crestor would be good options, as they are both stronger than Zocor (and Crestor is stronger than Lipitor).

To clarify what has been mentioned as a concern earlier, for someone with multiple risk factors for coronary artery disease, the new concensus from the ACC is to basically try drive down the LDL as far as it will go. The latest published standard has been to have LDL < 100 in people with multiple risk factors, however there have been a number of more recent studies that have shown that even lower LDL's than 90-100 have been associated with increased survival in post-MI patients. Many cardiologists feel that the current standards are too lenient, and will tighten lipid control measures in their high-risk patients even if they are already below 100.

 

[ultracet]

I would personally shy away from crestor... It has many ADEs that other statins don't share. I have seen patients hospitalized due to compications from this drug. If it is absolutely necessary there are certain monitoring requirements that must be utilized in order to assure patient safety.

I just wandered in to this forum from the pharmacy side of medicine. I would like to recommend a valuable resource (more than likely for your own personal benefits rather than your patients just because there is never enough time).
www.pharmacyonesource.com
you can register for free and you can wade through the pharmacy stuff and look up drug info, interactions, and monographs.

 

[punjabiMD]

If it is absolutely necessary there are certain monitoring requirements that must be utilized in order to assure patient safety.

what is monitored? is a baseline CK level taken before initiation of treatment and then monitored throughout (I had read some literature suggesting that CK monitoring is one possible way to prevent ADE)? or are there other ways?

 

[Boomer]

zetia is one option, but most people would switch to a stronger statin first. The fewer meds a patient has to take, the better. Crestor was not taken off the market (although there are class action lawsuits meant to pad lawyer's income that may do that). Baychol was a statin which was taken off the market a few years ago thanks to all of the litigation. Crestor's release was delayed because the company was worried about litigation since it was scheduled to be released around the same time that Baychol was being recalled, plus the FDA was worried about it since it had the added renal failure side effect. I don't think that there's anything particularly wrong iwth it though, especially if you are taking low dosages, since most of the side effects that the FDA was concerned about were only occuring at high dosages.

Based on the info in the original post, I was assuming 80 mg of Zocor, and sensing resistance to Crestor, so that was my thought process.

 

[Kalel]

Low dose Crestor is stronger (will reach lower LDL and total cholesterol levels) then 80 mg of Zocor. The ACC/NIH/whoever does the preventative guidelines will probably be amending LDL goals eventually. The most recent study showing benefits of LDL levels below 100 was done on patients with acute coronary syndromes, but there is another study in the pipeline looking at patients with coronary artery disease and LDL goals. One of my prof's seems to think that people don't need any LDL in the their blood stream since most cells are capable of synthesizing their own cholesterol. It'll be interesting to see if people can go around with close to 0 LDL. Pfizer is heavily invested in this new HDL raising drug too, so there should be some interesting changes with CAD management in the near future.

 

[AJM]

Yep, many of the cardiologists that I work with think that your LDL can never be too low. Their philosophy is that if you've had an MI and your LDL is 60, then your LDL is still too high. Several of them extend that thinking to their high-risk patients.

 

[drjeni2b]

thanks for your replies..actually my mom did try lipitor which worked very well except for unbearable muscle aches..she's been on the crestor (much to my dismay) for 4 days now; 10 mg per day. i'm just weary of her internist who constantly has "drug-of-the-week syndrome" induced by sleezy drug company people trying to fill their pockets..anyway if any one has any more ideas about CRESTOR, keep 'em coming! thanks

 

[rancherdoc]

I know from personal experience that Crestor works much more effectively than Zocor. I was on Zocor since 2001 after CABG X3. My total cholesterol stayed above 230 w/Zocor but dropped to 170 w/ 10 mg Crestor qd. Triglycerides dropped from 400+ to 180. LDL dropped to 60 from 150. I have had no side effects but do LFT every 3 months. AST and ALT have not risen significantly. I am willing to take the risks ( while being closely monitored) in order to avoid having surgery again. As we know results of rework bypass generally aren't that good. Don't be afraid of Crestor-just be aware that it can cause problems in some people as all statins do.