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Ask a Pharmacist (Expert Forum)
Changes to lipid control drugs
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Changes to lipid control drugs
by stripeytiger, Nov 18, 2008 08:49PM
My Asthma Dr. said that he would consider changing from Lipitor 5 mg to Crestor (dosage not yet mentioned) after 1 more blood test. 3 years ago another dr. suggested a change, but cardiologist said no need to. Another Dr. (forum) suggested using, in addition to Fish oil for tri-glycerides, niacin. And he said statin users should take CO-enzyme Q 300 mg. But I do not know if these are general recomendations based on research or if they fit my own profile, which is
Triglycerides 89 (lowest they have been)
HDL 51 (has fluctuated between 50 and 68))
LDL 86 (lowest yet)
CK protein 290 (where normal is 40-180).---> I HAVE NO MUSCLE PAIN
ALT 29.8 where normal is -25
AST--28 where normal is 10- 30)
Blood pressure varies...for many years it has been 127/75. Now it varies from 139/86 to 120/85 to errors (when I get nervous the machine in the gym gives odd results). My weight down 5-8 pounds SINCE August (when blood test was done). Another was done yesterday. So, specifically given my Triglyceride, HDL and LDL levels, intake of 4 grams fish oil, lipitor 5mg, aspirin,
(1) Is there any reason why one would go to crestor vs. current lipitor. Don't understand why Drs. push it (I think crestor is very aggreesive in marketing). Original cardiologist saw no need to change, but I keep getting suggetions to change it, maybe due to HDL. But I think statin does not affect HDL so much?
(2) Japan does not yet have OMOCOR (EPA/DHA). Current drug is Epadel by Mochida (ALL EPA).. So I take over the counter one and prescription half and half. Is there any opinion of whether all EPA/DHA or EPA only is more effective. Omocor comes next year,
(3) Given my above cholesterol and triglyceride figures and regimen, is there any evidence that taking niacin would
be better than the fish oil alone I am taking? It seems already to be in a good range.
(4) Have you heard that 300 mg of CO Enzyme Q is warranted for a person taking a statin EVEN THOUGH no muscle pain. Thank you!
Triglycerides 89 (lowest they have been)
HDL 51 (has fluctuated between 50 and 68))
LDL 86 (lowest yet)
CK protein 290 (where normal is 40-180).---> I HAVE NO MUSCLE PAIN
ALT 29.8 where normal is -25
AST--28 where normal is 10- 30)
Blood pressure varies...for many years it has been 127/75. Now it varies from 139/86 to 120/85 to errors (when I get nervous the machine in the gym gives odd results). My weight down 5-8 pounds SINCE August (when blood test was done). Another was done yesterday. So, specifically given my Triglyceride, HDL and LDL levels, intake of 4 grams fish oil, lipitor 5mg, aspirin,
(1) Is there any reason why one would go to crestor vs. current lipitor. Don't understand why Drs. push it (I think crestor is very aggreesive in marketing). Original cardiologist saw no need to change, but I keep getting suggetions to change it, maybe due to HDL. But I think statin does not affect HDL so much?
(2) Japan does not yet have OMOCOR (EPA/DHA). Current drug is Epadel by Mochida (ALL EPA).. So I take over the counter one and prescription half and half. Is there any opinion of whether all EPA/DHA or EPA only is more effective. Omocor comes next year,
(3) Given my above cholesterol and triglyceride figures and regimen, is there any evidence that taking niacin would
be better than the fish oil alone I am taking? It seems already to be in a good range.
(4) Have you heard that 300 mg of CO Enzyme Q is warranted for a person taking a statin EVEN THOUGH no muscle pain. Thank you!
Age
:
56
Sex
:
Male
Weight
:
About 88 kilos
Current Medications
:
Japan brands in some cases) Lipitor 5mg, BayAspirin 100 mg (dissolves in colon), plus Flotide (asthma), singulair, mukosta (for Gerd-related reflux, another drug for sputum control, proton pump inhibitor (takepron), EPA/DHA over the counter AND/OR EPADEL, which is 100 percent prescription EPA
Also take 1 red wine or two a day most days, walk 4 times a week for 1 hour or more
Japanese diet high in salt, but I try not to use additional
Also take 1 red wine or two a day most days, walk 4 times a week for 1 hour or more
Japanese diet high in salt, but I try not to use additional
Drug Allergies
:
None
Medical Conditions
:
Asthma (under control), Past ulcer, (no helico pylori, just past overuse of ibuprophen probably in 2002 for back pain). angioplasty (no stent) in 2002 followed by two checks (catheterization and CAT-no restenosis as of this year)
Doctor's Answer
by Sandra Y, RPh, Nov 20, 2008 11:31AM
, Nov 20, 2008 11:31AM
1) In studies comparing equal doses of Crestor to Lipitor, Crestor has been shown to lower LDL levels ~10% and increase HDL levels 2-4% more than Lipitor. Your triglyerides, total cholesterol, and LDL's are in the optimal range, and your HDL level is in the middle. Based on these numbers, there doesn't seem to be a need to switch to Crestor.
2) There is little evidence on the use of EPA alone. Lovaza/Omacor and most fish oil supplements are available as a combination of both EPA/DHA, has been shown to reduce triglycerides.
3) Response to over-the-counter supplements vary from person to person, so the effect of niacin vs. fish oil on your triglyceride level is unknown.
4) There is some evidence that coenzyme Q10 may help with statin-induced muscle pain, but there is not any well-documented studies to support its use.
2) There is little evidence on the use of EPA alone. Lovaza/Omacor and most fish oil supplements are available as a combination of both EPA/DHA, has been shown to reduce triglycerides.
3) Response to over-the-counter supplements vary from person to person, so the effect of niacin vs. fish oil on your triglyceride level is unknown.
4) There is some evidence that coenzyme Q10 may help with statin-induced muscle pain, but there is not any well-documented studies to support its use.
Today I was told by ONE doctor that LDL should be 70, but you and another dr said it is ok. He said i should try 40 mg, but that seems HIGH. I am ONLY taking 5 mg (normal in Japan). And even with 40 my CK levels are high , but no pain. So a bit confused.