Re: Statin Myopathy - Cmax or AUC
- From: Jason@xxxxxxxxxx (Jason)
- Date: Mon, 07 May 2007 14:31:08 -0700
In article <rqvu33dbv6u8f68if3itoihf0k5auilkaf@xxxxxxx>, jay1000
<jfschonSpamguarD@xxxxxxx> wrote:
On Sat, 05 May 2007 19:43:18 -0700, Jason@xxxxxxxxxx (Jason) wrote:
In article <d4sp33lvg9cnpqcjk69e6f80fvms4nocmj@xxxxxxx>, jay1000Jason
<jfschonSpamguarD@xxxxxxx> wrote:
I have developed myopathy on just about every statin except Lescol,
the statin of last resort, according to Jay Cohen's book. So next
visit I will ask my doctor about giving Lescol a try.
In checking out Lescol, I discovered they have regular 20, 40 & 80 mg
capsules plus an 80 mg controlled release tablet. So my first thought
was try the 20 mg - it should have minimum potential for causing
myopathy. But in looking over the Lescol data I spotted two variables
of interest. First is C sub max, the maximum plasma concentration of
fluvastatin. Second is AUC, the area under the concentration versus
time curve.
With 20 mg dose C sub max is ~170 and AUC ~200
With 80 mg extended release C sub max is ~100 and AUC ~650
AUC should theoretically correlate with cholesterol reduction.
Question is which variable should best correlate myopathy? There is
no consensus on the cause of myopathy so I am fairly sure there are no
correlations. Any speculations, other than Lescol will be like all the
other statins and I'm screwed.
~~~~~~~~~~~~~~~~~~~~~~~~~~~
I suggest that you follow the advice on pages 154 and 160 of Jay Cohen's
book related to splitting pills and his advice on pages 8 to 15 related to
precision prescribing. Start with a very low dose and work up slowly to
find the dose that is right for you--every person is different. After
about a month, you should know whether or not you will develop myopathy.
If you do not develop myopathy, you could move to a higher dosage. It may
take 6 months or longer before you detemine the best dose for you. If you
develop any signs of myopathy, move back to the dosage level that did not
cause any symptoms of myopathy. That is the way Doctor Cohen recommends
that doctors do it but as we both know--most doctors don't have the time
or energy to practice precision prescribing. (They sell pill splitters at
most drug stores.) I had to stop taking statins due to the side
effects--memory problems and other problems. Make sure you take lots of
CQ10--see pages 60-61 and 125-126.
Jason
Thanks, I've got Jay Cohen's book but he does not address the use of
extended release statins. So my question is why is less better? If
it is because C sub max is lower then I go with 80 mg extended
release. If it is because AUC is lower then I go with 20 mg
once-a-day.
But since the mechanism of statin induced myopathy is not known, I
really don't expect an answer. My fallback is the 20 mg capsules
although I would dearly love to be able to go with the 80 mg extended
release tablets.
I have been on CoQ10 500 for a year and it has done nothing to prevent
myopathy on three different statins. Based on personal experience,
it's highly overrated.
In the interim, while I am off all statins, I am using Questran, Omega
3 fish oil capsules and Benecol stanols. I'll have my doctor run a
blood test before starting Lescol just to see how I'm doing.
Jay
~~~~~~~~~~~~~~~~~~~~~~
Jay,
Please keep in mind that I am now a doctor. I can only tell you what I
would do if I were in your shoes. Doctor Jay S. Cohen makes it clear in
his book that a 20 mg dose statins is less likely to cause myopathy and
other side effects than a 80 mg dose of statins so for that reason--I
suggest that you stay with the 20 mg dose and I do not advise you go to
the 80 mg dose since you have had problems with myopathy on three
different statins. I don't believe you should try the 80 mg extended
release tablets. Have you tried Zetia which is a cholesterol lowering drug
that works differently than statins? It does have side effects. Doctor
Cohen discusses Zetia on pages 57 and 111. I have read that Provachol 10
mg dose is the safest statin. The supplements you are taking should help.
You should also consider eating meat only once per day or perhaps only
once per week. I read a book that was written by a doctor and he stated
that eggs do not cause an increase in a person's cholesterol. That was
good news for me. Eggs have lots of really good protein. Upon request,
I'll provide the title of the book and the name of the author. I wish you
well.
jason
.
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