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Medical Forum / General / Cardiology / January 2006Quiting Statins up date
Hello, Some time ago, back in Sept of 2004 I wrote here that I was going to quit statins on my own since I could not reason with my doctor regarding muscle weakness problems I had and their possible link to statins. Over a short period of time the muscles in my legs, back and neck were getting weaker and weaker -- even while I was still excercising 3 times a week. I did quit zocor for about 6 months and started noticing some improvement. But it was very slow -- so slow I had to question my decision. After 6 months my doctor talked me into taking zocor again. It took about two weeks for muscle problems to come back with a vengence. My neck became so sore and weak that I could hold it upright only with great effort and not for very long. I quit zocor again. This time it's been about 9 months and I can notice significant improvement. I can walk better, and I can hold my head upright when walking for extended periods -- that's something I haven't been able to do for almost two years. I agree with others who have told me that I'm taking a significant risk by quiting the zocor, and I'm sure not recommending it to anyone without the participation of a doctor. I don't know yet if it's worth the risk for me. I just know that I'm finally getting better. robre > Hello, > [quoted text clipped - 23 lines] > > robre robre, I think that you made the correct decision. I also stopped taking statins due to the side effects. I suggest that you read this book. You should start taking the alternatives to statins that are mentioned in the book: "What You Must Know About Statin Drugs and Their Natural Alternatives" by Jay S. Chohen, M.D.  SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. I'm going to have to check that book out. Thanks for the reference. I've been hearing about a study that shows almost no benifit for someone starting statins at my age anyway (just shy of 60). I was absolutely amazed when my 82-year-old dad was in the hospital a month ago for heart related problems and the doctor prescribed zocor for him!! Good grief! robre robre, Congratulations on your improvement. How unfortunate that your doctors caused you further harm by not heeding the warnings of the NIH NHLBI, American Heart Association, and American College of Cardiology to discontinue statins immediately upon symptoms of muscle pain and weakness. As you improve, please be cautious in keeping your level of exercise at a very gradual increase. If you begin to experience attacks of gout, back off on the exertion. The reason: If the statin did damage to the mitochondria within your muscle tissue (cell walls), the muscle cells will not be fully capable of normal respiration (OxPhos exchange). As they become starved, some start to die off (apoptosis). There is a mechanism the body uses to halt muscle cell die-off, it releases excess amounts of uric acid. That stops the muscle cell die off, but then the uric acid precipitates into very sharp crystals and they settle with gravity, usually into the joints of the feet, but they can go elsewhere. This causes a severe rheumatism reaction, GOUT. The gout is extremely painful in and of itself, and the rheumatologist might assume you have eaten too much beef or other foots that typically cause gout. (and gout can be caused that way, of course) However, if you have not consumed such food and the gout episodes follow within 24 to 36 hours of our having engaged in some physical activity, be certain to bring this to the doctor's attention. By 'exertion' I'm not talking weight lifting or marathon running here, something as slight as packing for a weekend-trip and lifting the bags into the car, then out of the car at the destination can cause such a severe gout reaction as to merit an emergency hospital visit in a person who has sustained statin muscle damage. Not much has been published on this phenomenon experienced by many recovering statin-damaged patients, but several doctors have confirmed that the relationship exists between gout and statin myopathy. Best of luck in your continued improvement, and Happy New Year! Sharon References: Dr. Graveline's website discussion of Gout and Statins http://www.spacedoc.net/statins_gout.htm From Pub Med: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15911208&query_hl=2&itool=pubmed_docsum Clin Geriatr Med. 2005 Aug;21(3):577-88, vii. Iatrogenic rheumatic syndromes in the elderly. Quiceno GA, Cush JJ. Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231-4496, USA. Rheumatic complaints are common in the geriatric population. However, uncommonly autoimmune or musculoskeletal complaints and disorders may arise as a consequence of pharmacotherapy. These rare events include statin myopathy, drug-induced lupus, arthralgias, vasculitis, or tight skin syndromes. This article will discuss the possible iatrogenic causes of rheumatic conditions, potential inciting agents, and the various types of rheumatic manifestations seen in the elderly. Publication Types: a.. Review PMID: 15911208 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15914514&query_hl=6&itool=pubmed_docsum Ann Pharmacother. 2005 Jul-Aug;39(7-8):1358-61. Epub 2005 May 24. Acute myopathy in a patient with concomitant use of pravastatin and colchicine. Alayli G, Cengiz K, Canturk F, Durmus D, Akyol Y, Menekse EB. Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey. alayli70@yahoo.com OBJECTIVE: To report a case of acute myopathy after concomitant use of colchicine and pravastatin. CASE SUMMARY: A 65-year-old woman was admitted to the hospital with an acute episode of gout. She had been taking pravastatin 20 mg once daily for 6 years. On admission, blood urea nitrogen and serum creatinine levels were 48 mg/dL and 1.3 mg/dL, respectively. Colchicine 1.5 mg/day was added to the treatment regimen, but 20 days after the initiation of colchicine therapy, symmetrical proximal muscle weakness developed in the woman's legs. Physical examination, laboratory findings, and electromyelogram findings suggested myopathy. The Naranjo probability scale indicated a probable relationship between myopathy and combined therapy. Seven days after discontinuation of colchicine and pravastatin, the patient's weakness improved and enzyme levels returned to normal. Colchicine was restarted at 1.0 mg/day 5 days later; no myopathy occurred. DISCUSSION: Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and colchicine are known to cause myopathy. Most of the statins and colchicine are biotransformed in the liver primarily by the CYP3A4 system, which may increase the risk of myopathy when concurrent therapy is used. However, pravastatin is not primarily metabolized by cytochrome P450 isoenzymes. The cause of myopathy in our patient may be related to the interaction of colchicine and pravastatin via P-glycoprotein. In addition, the presence of mild renal dysfunction could have contributed to the development of myopathy. CONCLUSIONS: We suggest that clinicians be aware that neuromuscular toxicity can occur in patients with mild renal dysfunction with combined use of colchicine and pravastatin. Publication Types: a.. Case Reports PMID: 15914514 [PubMed - indexed for MEDLINE] > Hello, > [quoted text clipped - 23 lines] > > robre Thanks for that info, Sharon. I'd never heard that before. I've been starting exercise again, but I've been limping into it. I'm still pretty tickled about being able to walk through the grocery store and being able to stand up straight. robre I'm going to have to talk to my dr about dropping Vytorin. However, what else can be done to keep my cholesterol in check? It's not a diet issue it's genetic. > I'm going to have to talk to my dr about dropping Vytorin. However, > what else can be done to keep my cholesterol in check? It's not a diet > issue it's genetic. I suggest that you read this book and start taking the alternatives mentioned in the book: "WHAT YOU MUST KNOW ABOUT STATIN DRUGS AND THEIR NATURAL ALTERNATIVES" by Jay S. Cohen, M.D. I only wish that I had read the above book before taking statins. I had to stop taking statins due to the side effects. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. >> I'm going to have to talk to my dr about dropping Vytorin. However, >> what else can be done to keep my cholesterol in check? It's not a diet >> issue it's genetic. > > I suggest that you read this book and start taking the alternatives > mentioned in the book: I suggest you discuss the options with your health care provider > "WHAT YOU MUST KNOW ABOUT STATIN DRUGS AND THEIR NATURAL ALTERNATIVES" > by Jay S. Cohen, M.D. > > I only wish that I had read the above book before taking statins. I had to > stop taking statins due to the side effects. jason@nospam.com (Jason) wrote in news:jason-2101061843190001@66-52-22- 14.lsan.pw-dia.impulse.net: >> I'm going to have to talk to my dr about dropping Vytorin. However, >> what else can be done to keep my cholesterol in check? It's not a diet [quoted text clipped - 8 lines] > I only wish that I had read the above book before taking statins. I had to > stop taking statins due to the side effects. Actually, you took statins (2 different ones) for about three months concurrent with taking Red Yeast Rice capsules (already a mistake), experienced some muscle pain which quickly dissipated when you stopped and subsequently diagnosed yourself with "memory problems" which you used as a reason to (somewhat hastily IMO, based on a self-diagnosis) quit your job. L. > Hello, > [quoted text clipped - 23 lines] > > robre Any sense in trying other statins? Or was Zocor not the first one you were on? I understand the side affects can differ from statin to statin and individual to individual. Larry E >> Hello, >> [quoted text clipped - 27 lines] > on? I understand the side affects can differ from statin to statin and > individual to individual. many have side effects with one...and not on another my hubby started Lipitor after his MI and stent...got terrible muscle pains...doc stopped it...of course lipids went right back up.....2 months later started him on Pravachol....5 years later...no repeat problems with Pravachol..and lipids are lovely... YMMV > Larry E Exactly, the dosage is also significant in the likelihood of severe disabling statin AEs. Hawki didn't mention the dosage her husband was on for either drug, but an 80 mg/day dose of Pravachol is less potent than a 10 mg/day dose of Lipitor. There are huge differences in the potency (dose effects) per mg across the statin class of drugs. In other words, a patient would need to take more than the maximum recommended dose of Pravachol to get a dose similar to the weakest available Lipitor dose. BTW, Zocor 20 mg/day is a higher dosage than Pravachol 80 mg/day. ref: http://www.drugdigest.org/DD/Comparison/NewComparison/0,10621,37-15,00.html >>> Hello, >>> [quoted text clipped - 38 lines] > >> Larry E It seems to me I heard somewhere that <Hawki63@sbcglobal.net> wrote in article <wncyf.2839$nT6.241@newssvr27.news.prodigy.net>: >>> Hello, >>> Some time ago, back in Sept of 2004 I wrote here that I was going to >>> quit statins on my own since I could not reason with my doctor >>> regarding muscle weakness problems I had and their possible link to >>> statins. Over a short period of time the muscles in my legs, back and >>> neck were getting weaker and weaker -- even while I was still >>> excercising 3 times a week. >>> I did quit zocor for about 6 months and started noticing some >>> improvement. But it was very slow -- so slow I had to question my >>> decision. After 6 months my doctor talked me into taking zocor again. >>> It took about two weeks for muscle problems to come back with a >>> vengence. My neck became so sore and weak that I could hold it upright >>> only with great effort and not for very long. I quit zocor again. >>> This time it's been about 9 months and I can notice significant >>> improvement. I can walk better, and I can hold my head upright when >>> walking for extended periods -- that's something I haven't been able to >>> do for almost two years. >>> I agree with others who have told me that I'm taking a significant risk >>> by quiting the zocor, and I'm sure not recommending it to anyone >>> without the participation of a doctor. I don't know yet if it's worth >>> the risk for me. I just know that I'm finally getting better. >> Any sense in trying other statins? Or was Zocor not the first one you were >> on? I understand the side affects can differ from statin to statin and >> individual to individual. >many have side effects with one...and not on another >my hubby started Lipitor after his MI and stent...got terrible muscle >pains...doc stopped it...of course lipids went right back up.....2 months >later started him on Pravachol....5 years later...no repeat problems with >Pravachol..and lipids are lovely... OTOH, I was started on Pravachol and its effects were too weak to help, so my doctor changed me to Lipitor and within a short time raised the dose to 80mg. That was over seven years ago and I have had no problems with muscles or liver function or mental agility (any of those three could be attributed to age in my case, if they were present). SignatureDon Kirkman > It seems to me I heard somewhere that <Hawki63@sbcglobal.net> wrote in > article <wncyf.2839$nT6.241@newssvr27.news.prodigy.net>: [quoted text clipped - 42 lines] > with muscles or liver function or mental agility (any of those three > could be attributed to age in my case, if they were present). yes...should have mentioned that I too started on pravachol...not much lipid reducing..but no side effects...then switched to Lipitor...LDL to 100..also no side effects ...both of us are on pretty low doses as well Larry, the rate of reoccurrence of statin adverse effects when a patient is rechallenged by a statin is quite high, regardless of brand. All are HMG Co A Reductase Inhibitors, after all. Also, the higher the dosage, the more likely the AEs (net dosage, not mg of a brand - Jay Cohen's book is a good source for equivalence of dose across brand). That is true for damage by the initial statin and for damage by rechallenge statin. Be aware, however, (also from Cohen's book) that the lowest starting dosage is too high for 50% of the target patient population. Be aware, too, that there is a diminishing capability for recovery when there is statin damage. For example, the highest degree of recovery from statin cognitive damage seems to be 80% of the pre-statin capability. Thus, on rechallenge, the greatest recovery that can be hoped for is 80% of the remaining 80%. In other words, a patient who suffers statin cognitive adverse effects on a first and then a second statin can - at the VERY BEST RECOVERY POSSIBLE - hope to be left with only 64% of his original cognitive abilities. This is from a presentation of study findings that was delivered verbally at a conference - not linkable via the net. Similar results also were given for statin re-challenge for the other 2 most common adverse effects, muscle damage and nerve damage. In the case of muscle & nerve damage, there were higher rates of AE on third rechallenge. In the case of cognitive adverse effects from statins, not one of those patients left with only 64% or less of their normal cognitive ability (that is the max recovery, not all achieve the max) was willing to chance going on a third statin, so there are no numbers for that. >> Hello, >> [quoted text clipped - 29 lines] > > Larry E I've said it before here. I was given Zocor 10 then a higher dose. Still lipid were flat ( no Change.) Then Lipitor 40 no change, then my cradio guy's nurse said lipitor 80. Well after four years of no change my muscle calf went to 14 from 18 inches. Aches and joint pain too. Still weak by my standards and ldl is 160. HDL however with niacin was ~70. I am currently working on lowering BP and increasing lung capacity and muscle growth. I also ordered 65 calediums for spring planting and was about trimming hardwood plants today. No more drugs for me a secondary kind of guy. CABG 4 Bill SignatureGarden Shade Zone 5 S Jersey USA This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. Vision Problems? Look at http://www.ocutech.com/ ~us$1500 > Larry, > [quoted text clipped - 64 lines] >> >>Larry E Thanks for the info, Sharon. Everyone knows that Statins (along with lots of other drugs) can have adverse effects. The PDR is full of them. I was merely pointing out to the OP that everyone is an individual, that different drugs affect different individuals differently, that in some cases one can have no or minimal adverse effects from one drug and not from others in the same class of drugs, and that another statin might be worth a try. Larry E. If you are concerned about risk by not taking a statin, then you should read: http://www.second-opinions.co.uk/mislead.html When you are through, then you might want to click on the "Fats, chloresterol and heart disease" link on the bottom of the page. eldred And the risks of disabling statin AEs, muscle damage, chronic pain, nerve damage, cognitive damage, short-term memory loss, amnesia, aphasia, retinal damage, kidney and liver damage need to be considered, too, in going for a 96.8% chance of surviving with statin treatment, when comparing against a 96% likelihood of surviving with no treatment at all. > If you are concerned about risk by not taking a statin, then you should > read: [quoted text clipped - 5 lines] > > eldred > And the risks of disabling statin AEs, muscle damage, chronic pain, nerve > damage, cognitive damage, short-term memory loss, amnesia, aphasia, retinal > damage, kidney and liver damage need to be considered, too, in going for a > 96.8% chance of surviving with statin treatment, when comparing against a > 96% likelihood of surviving with no treatment at all. The article had no such statistics for statins. In the long run there is no difference between the two - 100% death rate. Thus it is important to give the time period to which the statistics apply - which the author did not do. In the absence of that, relative risk reduction is important. Improvements in areas other than death - such as lower number of strokes - are also important. Bill >> If you are concerned about risk by not taking a statin, then you should >> read: [quoted text clipped - 5 lines] >> >> eldred how can relative risk reduction be so important? what is the absolute risk reduction? > how can relative risk reduction be so important? what is the absolute > risk reduction? Because they don't give you a time period. For example, if you know that taking this pill improves your chance of staying alive by .5% (absolute) over the next 1 year that is a very good deal. If it is over 20 years it does not sound as good. In the absence of anything else, if you know it halves your risk of dieing, that helps. Bill Robre, I've been on Vytorin for seven months now and I've heard about these muscle soreness issues. Can you please tell me if there is a difference between the muscle sorness I feel after my usual workouts and those caused by statins? I'm glad you're feeling better. Javier You know I never had a lot of pain. For me it was like when you work a muscle to the point where it can barely function. I had it especially bad in my legs at first. I went from walking 1 to 2 miles a day to where my legs were just completely gone after three blocks. The last place it hit was in my upper back and neck. I literally could not hold the weight of my head up. Sitting in a chair I would have to prop my chin on a crooked arm. But, the orginal question was about pain. Like I said, my reaction was more about weaknes than it was about pain, and any pain that I did have went away when I was not using the muscle. I've heard lots of people, though, talk about terrible pain in their hands and knees. robre The pain seems to be a mixture of muscle damage and peripheral neuropathy (several studies have established that statins cause peripheral neuropathy and polyneuropathy, most notably those by Dr. Gaist). The muscle weakness - barely functioning - tends to be due to mitochondrial damage that interferes with the muscle cells' ability to exchange oxygen and electrons - cellular respiration. Our lungs 'breathe' for us, but that oxygen gets carried to the cells and the mitochondria in the cell walls are what lets the cell breathe. You are not alone in this - see, for example, very very similar descriptions by patients like you in the reprint of the Smart Money Magazine article, the Lipitor Dilemma, by Eleanor Laise: http://www.n3inc.com/SmartMoneyReprint_103003Web.pdf I think you will be astonished to see how much like you these people described their statin muscle effects. One said, "I couldn't hold a fork to eat a meal." Muscle cells contain approximately 20 minutes worth of energy (ATP). Once that is expended, the Ox-Phos cycle kicks in and energy is replenished via the exchange of oxygen and electrons through a healthy mitochondria. (the runners' call this getting a second wind) Coenzyme Q10 is something that is normally manufactured by the body and essential to healthy cell walls (and it fulfills many other essential roles in the body). The statins (HMG CoA Reductase Inhibitors) interrupt this processing and prevent the body from creating CoQ10, causing a deficiency. This statin mitochondrial damage to skeletal muscle cells can be verified by a muscle biopsy, and has been documented by Dr. Phillips and others. In the case of statin myopathy (muscle damage, muscle pain, muscle wasting, weakness, with or without elevated CK), the cell is damaged enough that once the ATP is depleted the cell begins to break down and die (apoptosis). That releases toxins into the system and enough of this can cause the kidneys and liver to fail (rhabdomyolysis). So, the pain and the muscle weakness can be combined from one cause, or can appear independently if the pain is more from neurological damage and the weakness is more from the muscle damage. So glad you are on the mend. > You know I never had a lot of pain. For me it was like when you work a > muscle to the point where it can barely function. I had it especially [quoted text clipped - 10 lines] > > robre |
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