Saturday, September 22, 2018

If you have stopped taking a statin drug because of side effects, try again with low-dose Crestor

The lowest dose of Crestor does most of the work. Increasing from 5 to 40 mg, an eight-fold increase, only results in about a 40 percent increase in cholesterol reduction.
    A lot of people are prescribed cholesterol-lowering statin drugs by their doctors and stop taking them because of unwanted side-effects, such as muscle pain. There is a lot better solution than simply not taking the drugs: just take them less often or at a much lower dose.
    My cholesterol has been hovering between 200 and 240 for my entire adult life, and my doctor has suggested several times that I take Crestor. A few years ago he gave me enough samples of 20mg Crestor to last six months, but I didn’t take them. Crestor was still on-patent at the time; I probably could have made money peddling my pills around nursing homes.
    After my last cholesterol screening my doctor's nurse called to tell me that he was prescribing me 10 mg Crestor to be taken every day. When I mentioned that I would rather just take it a couple of times a week she told me that he would have to increase the dosage to 20 mg., so I settled for the 10 mg every-day Crestor. Arguing with a doctor's nurse if futile.
    You can lead a man to pills but you can’t make him take them; I ended up taking the 10 mg Crestor about once a week, maybe a little more. There is a reason for my reticence in not wanted to take 10 mg of Crestor every day. Some years back I listened to a radio program which described Crestor as being the very strongest and most effective statin on the market; the downside to that is that it tended to have more side effects at higher doses. The point was made on the show that patients are usually best served by taking a very low dose of a powerful statin -- and Crestor is the strongest -- than a higher dose of a less-powerful one.
    One study found that 5mg of Crestor daily reduced LDL-C by 39% and non-HDL-C by 35%;  10 mg reduced LDL-C by 44% and non-HDL-C by 40%; 20 mg reduced LDL-C by 50% and non-HDL-C by 45%; 40 mg reduced LDL-C by 55% and non-HDL-C by 50%. Note that while high doses of Crestor do cause a greater reduction in cholesterol, the reduction is by no means linear. Increasing the 5 mg dose by 300 percent only results in a 30 percent increase in cholesterol reduction; a 700 percent dosage increase only increases efficacy by 40 percent. On the other hand drug toxicity, as measured by the occurrence and severity of side effects, rises with the dosage in a more-or-less linear fashion.
    Now for the takeaway. I’ve been taking 10mg of Crestor once every five to seven days for several months. I just had my total cholesterol checked for free at Wal-Mart and the result was 136, down from 206 in March. I still need to get a full cholesterol check, but that number confirms that a very low dose of Crestor can have a tremendous effect on lowering cholesterol. In Japan Crestor is marketed with a 2.5 mg dosage; sadly, we don’t have that option, but it is possible to use a pill splitter, and that’s what I’m likely to start doing after my next doctor’s visit.
    I’m not sure I will burden my doctor with the fact that I plan to split a 5 mg Crestor; I’ll just do it and check my cholesterol after a couple of months. In all likelihood it will be lower than 136, which should be plenty low.
    To anyone who has quit taking their statin drug because of unwanted side effects, I would suggest starting them again with a lower dose, either by taking them every other or every third day or with the use of a pill splitter, or both. Ask for low-dose Crestor if your doctor will cooperate; make your own low-dose Crestor regimen if he won't.