Yikes! I guess it is best not to use more than one statin.
However I have found data that the triple combo of Bempedoic Acid, Ezetemibe and Atorvastatin is a winner. So, I’ll stick with that. Thanks for the info @CronosTempi
3 Likes
mccoy
#1299
Did he hint at the cause of such detrimental effect of combinations?
No, and there was so much to discuss I never had the time to press him on that point. I’m curious myself. In general DDI (drug drug interactions), are super interesting and highly relevant to those of us on multiple meds. I scour pubmed for terms like ‘pitavastatin rapamycin sirolimus’ and there are hardly any hits (a few irrelevant about stents); ‘pitavastatin empagliflozin’ one irrelevant paper; ‘pitavastatin sglt2’ one paper and so on. Thin.
Thanks, RapAdmin. It doesn’t seem like a stellar idea to combine the two statins, but nothing about the liver. Maybe the cardiologist was speaking based on his clinical experience. In any case I’m not going to chance it, so I’m sticking to one at a time😁.
AnUser
#1303
You wouldn’t have any benefit anyway as you’re already inhibiting at HMGCR at the near maximum anyway. The smallest dose statins have the largest effect. If I were you I would measure liver enzymes before and after switching the statin as well since it’s a new drug after all. I do think the standard practice is measure liver enzyme a couple times after that too.
5 Likes
Yes, that’s a good suggestion, especially as I understand it elevated liver enzymes are one if the few “worse” side effects of pita compared to other statins. FWIW, my liver enzymes were completely unaffected by atorvastatin.
1 Like
RapMet
#1305
Thanks for the detailed explanation. I wonder though why wouldn’t your GP prescribe it (if you requested) and it is an FDA approved drug for that purpose especially knowing that Atorvastatin is not necessarily working as well as before. Maybe time to switch your GP LOL.
I have previously discussed pitavastatin with my doc. It has to do partially with insurance. Pitavastatin still doesn’t have a generic, so is more expensive than atorvastatin. Insurance will cover atorvastatin. The standard of care is to go for atorvastatin and stay with it if it is well tolerated, and if more is needed, to escalate the dose rather than switch the statin. Atorvastatin is the first line statin based on extensive clinical track record and effectiveness. My PCP is by the book, and bound by insurance rules. Switching my PCP makes no sense, since I would have to find another doc within the network, and the new doc would be still bound by the same insurance. I’m with UCLA, and the quality of docs at the teaching institution is top notch, and staying with UCLA allows for taking advantage of top specialists as they do referrals internally. The problem is the insurance limiting what the docs can prescribe. The insurance I get through work, and it’s very inexpensive. It used to be very good, but in the last few years has gotten much worse. Still, switching involves cost and hassle. My choice is go concierge (a very uneven bunch), but at this point I’m increasingly flying solo anyway. For now I want to stay with UCLA.
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Davin8r
#1307
Yes it does. He’s got no excuse to keep it from you.
2 Likes
Maybe it’s recent. I’ll ask him about it. If insurance will be amenable. If reasonable cost I’d pay out of pocket, although I’ve already bought 900 4mg pills from India,
RapMet
#1309
That’s a pretty good amount, you are all in on this “self-medication” journey lol.
BTW you got lucky on receiving all your shipments, mine was shipped on Sep 25 and has been stuck in customs at JFK since 10/01. Most likely has been thrown in a dust bin somewhere, but some have reported having theirs stuck for a month or more and still got them.
RapMet
#1310
Out of curiosity why would he want to keep it away from him (in your opinion). Could it be he gets a kickback (if there is such a thing) from the pharma that manufactures Atorvastin? or maybe he hasn’t investigated enough, or maybe he’s aware of some “significant” side effect?
Reason for asking is that I’m currently taking 2.5MG Rosuvastain and contemplating to going on another one of these classes of drugs. I was set on Atorvastain untill @CronosTempi mentioned some common side effect of ATOR that PITA didn’t have? So now I’m a bit confused and also unclear on which one would be a better choise for someone that is within the normal LDL but would like to still see it a bit lower. I guess, being a doctor (imaginary one in my case 
) isn’t as simply as it seems LOL
Davin8r
#1312
If the doc mistakenly thinks it’s brand-only, he might assume it’s not coverable by insurance and doesn’t want to waste time fighting a lost cause on insurance prior authorization headaches (which already consume far too much of our time).
1 Like
L_H
#1313
yes, this study showing a reduction in arterial stiffness from vit k2 was run for 3 years. I suspect it took a long time to get significant results. A 50% reduction in arterial stiffness is pretty remarkable though
https://www.thieme-connect.com/products/ejournals/abstract/10.1160/TH14-08-0675?device=mobile&innerWidth=393&offsetWidth=393
It seems its gone generic and is quite cheap now - see GoodRx.com
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AnUser
#1315
4 mg x 90 tablets is $100 at GoodRx, so that’s not so bad at all.
It’s sold by Teva so yeah it means it’s generic, ignoring the price and all.
2 Likes
jnorm
#1316
@DeStrider Do you have any studies on the combination of statin+ezetimibe handy?
I’m currently on 5mg rosuvastatin for a few weeks now with no side effects. I also have ezetimibe on hand, but will wait to see what rosuvastatin alone does before I add it in. But I recall seeing something posted here that ezetimibe+statin led to worse outcomes?
The combination of Ezetimibe and Statin: a new treatment for hypercholesterolemia - PMC.
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