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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Cecilia on September 9, 2007, at 3:52:25
My doctor is pressuring me to start a statin again, I gave up lovastatin because of the muscle pain, but my cholesterol keeps rising, despite having lost quite a bit, though still not enough, weight and eating very little saturated fat. Anyone have any data on which ones cause the least muscle pain, or are they really all basically the same? Cecilia
Posted by sam123 on September 9, 2007, at 19:41:49
In reply to Statins: which cause least muscle pain?, posted by Cecilia on September 9, 2007, at 3:52:25
Have you had the blood test that measures creatine phosphokinase (CPK) ? What were the results ?
http://en.wikipedia.org/wiki/Statin:
All commonly used statins show somewhat similar results, however the newer statins, characterized by longer pharmacological half-lives and more cellular specificity, have had a better ratio of efficacy to lower adverse effect rates.The risk of myopathy is lowest with pravastatin and fluvastatin probably because they are more hydrophillic and as a result have less muscle penetration.
Posted by sam123 on September 9, 2007, at 19:47:29
In reply to Re: Statins: which cause least muscle pain?, posted by sam123 on September 9, 2007, at 19:41:49
Crestor (Rosuvastatin) seems to be better WRT muscle pain.
http://en.wikipedia.org/wiki/Rosuvastatin
Myopathy
As with all statins, some doctors have been hesitant to prescribe rosuvastatin because of concerns that this agent might have a higher incidence of rhabdomyolysis (a severe undesired side effect) than other statins; this negative impact on sales performance has been much more pronounced in the United States than in other countries. The FDA has indicated that "it does not appear that the risk [of rhabdomyolysis] is greater with Crestor than with other marketed statins", but has mandated that a warning about this side effect, as well as a kidney toxicity warning, be added to the product label.[6] However, more recent, larger and more thorough reviews have actually demonstrated both slightly lower rates of myopathy for rosuvastatin than any of the other statins available within the United States and improved kidney function with all statin use, including rosuvastatin, see below.
Regarding myopathy and potential rhabdomyolysis, recent reviews of published data on all statins marketed in the US, and reviewed by the FDA, both pre and post-approval, have found that marked rises in the serum levels of muscle CK enzymes to 10 times normal or greater, the hallmark of serious muscle problems, remain very rare, 1:10,000 to 1:20,000 individuals. (For comparison, this incidence is about identical with that for acetaminophen, commonly purchased as Tylenol, an OTC agent about which most people rarely worry; accept as safe)
Cerivastatin was an exception; it had a higher myopathy response. For the statins still on the market in the US, reported toxicity levels has been highest for pravastatin, simvastatin next, atorvastatin next and rosuvastatin the lowest at similar milligram doses. Yet the efficacy of these agents to change blood LDLipoproteins levels, at the same milligram doses, is the exact opposite. So, from the standpoint of the rare but serious muscle toxicity events, rosuvastatin, as of mid-2005 has turned out to have the best therapeutic index of the currently available statins.
Posted by Cecilia on September 9, 2007, at 23:17:53
In reply to Re: Statins: which cause least muscle pain?, posted by sam123 on September 9, 2007, at 19:41:49
I did insist my doctor order a CPK when I was having the pain from lovastatin, and it was normal, so of course my doctor concluded it was all in my head. I'm definitely leary of Crestor from what I've read about it and my HMO would never order it or any still on patent drug until I'd tried a few of the generic ones first. She suggested simvastatin, but it looks pretty similar to lovastatin from what I've read. Frankly, there's nothing in my life that makes me want to prolong it until my twilight years, but I'm terrified of having a non-fatal but disabling stroke and ending up in a nursing home.
Cecilia
Posted by sam123 on September 9, 2007, at 23:42:14
In reply to Re: Statins: which cause least muscle pain? » sam123, posted by Cecilia on September 9, 2007, at 23:17:53
I am doing well on Crestor + Tricor but in general I do not have problems with statins or fibrates.
Perhaps pravastatin or fluvastatin would be an option for you ? Fibrates Lopid and Tricor can have muscle related problems just like statins. Niacin
is another treatment, I have no experience with it.
Posted by Cecilia on September 10, 2007, at 0:53:56
In reply to Re: Statins: which cause least muscle pain?, posted by sam123 on September 9, 2007, at 23:42:14
I guess it's worth giving pravastatin or fluvastatin a try. Any idea where the data on these causing less muscle pain came from? I understandably don't think a doctor's going to consider Wikepedia as an authoritative source! Cecilia
Posted by sam123 on September 10, 2007, at 9:55:37
In reply to Re: Statins: which cause least muscle pain? » sam123, posted by Cecilia on September 10, 2007, at 0:53:56
I understandably don't think a doctor's going to consider Wikepedia as an authoritative source!
That excercise is left to the reader, you might check the links I sent you for supporting information.
Posted by nellie7 on September 11, 2007, at 13:47:34
In reply to Statins: which cause least muscle pain?, posted by Cecilia on September 9, 2007, at 3:52:25
Hi Cecilia,
I heard that statin-related muscle pain may be due to a deficiency in coenzyme Q-10 which may be a side effect of the medication. Supplementing with Q-10 may help.
Nellie.
Posted by Cecilia on September 12, 2007, at 6:14:41
In reply to Re: Statins: which cause least muscle pain? » Cecilia, posted by nellie7 on September 11, 2007, at 13:47:34
Thanks, Sam and Nellie, for your replies. I do take 50 mg coenzyme Q10/day, increased the amount to, I think, 100 or 150 mg when I was on lovastatin, still had the muscle pain. Unfortunately, because it's a supplement there isn't much research on the best amounts re safety and effectiveness-no profit for the drug companies. Cecilia
Posted by Sigismund on September 14, 2007, at 15:53:45
In reply to Statins: which cause least muscle pain?, posted by Cecilia on September 9, 2007, at 3:52:25
It's not what you asked about exactly but you might find this link interesting.......
http://www.lef.org/magazine/mag2003/sep2003_report_chol_03.html
Posted by Cecilia on September 23, 2007, at 3:10:58
In reply to Cholesterol » Cecilia, posted by Sigismund on September 14, 2007, at 15:53:45
Interesting article-I'm sure menopausal hormone drops must have contributed to my increased cholesterol as it's higher now than when I was 60 pounds heavier (and I eat very little saturated fat). But you usually read that hormone replacement therapy actually increases the risk of heart disease, for women anyway, not sure what it does for men. Basically, I suppose whatever meds we take or don't take we're all guinea pigs, especially if we're on a lot of different meds that form a chemical soup in our bodies. Cecilia
Posted by Sigismund on September 23, 2007, at 18:06:10
In reply to Re: Cholesterol » Sigismund, posted by Cecilia on September 23, 2007, at 3:10:58
>But you usually read that hormone replacement therapy actually increases the risk of heart disease, for women anyway, not sure what it does for men.
If the hormones are bioidentical and bring the hormone profile into optimum range, a number of beneficial changes should result, on things like BPH (for men) and cholesterol.
Posted by Cecilia on September 23, 2007, at 19:35:16
In reply to Re: Cholesterol » Cecilia, posted by Sigismund on September 23, 2007, at 18:06:10
I suppose it's the bioidentical part that makes the difference, all those studies showing how bad HRT was for women were using hormones made from horses urine (yuck). Of course I know my cheap HMO would never do any of those tests, let alone prescribe bioidentical hormones, they'd rather just put me on a statin. Cecilia
Posted by saturn on September 27, 2007, at 17:58:20
In reply to Statins: which cause least muscle pain?, posted by Cecilia on September 9, 2007, at 3:52:25
I don't know but statin-induced myopathy may be related to statin-induced reduction of Coenzyme-Q (Co-Q) levels. So *theoretically*, Co-Q supplementation could minimize statin-induced myopathy.
Posted by pipsywiggins on December 31, 2007, at 0:54:10
In reply to Re: Statins: which cause least muscle pain? » Cecilia, posted by saturn on September 27, 2007, at 17:58:20
Yes, but then you have the battle of the CoQ10 's
Who's got the best absorption? All kinds of new buzz words out there now make deciphering the legitimate value of dosage impossible.
pipsywiggins
This is the end of the thread.
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