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Doctors' Answers to "Frequently Asked Questions" - Lipitor


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/19/2000]
Question: My husband is currently on Lipitor, due to elevated Cholesterole of 250,
after taking this drug for 3 months, his cholesterole dropped to 160.
This was without change in diet or exercise. He had complained to his
Cardiologist about being tired after taking this drug, but there could
of course be other factors such as his work schedule of swinging shifts
weekly and rotating days off. His Dr. has done blood work and said all
seems normal.

It wasn't until after he started taking Liptor that he
found that once you take it, you have to take it for life. Is this
true? Had he known that, he would have attempted to change his diet
first.

He is also on Singular and Vancanese pocket inhaler for asthma.
Your comments would be greatly appreciated.

Janice McNamee


Answer: He can still lose weight and follow a strict diet and correct his cholesterol. This might allow cutting or stopping the lipitor. One is not addicted to lipitor, but most patients will not lose the weight necessary to correct their cholesterol, so we get jaded.

[posted 09/22/2000]
Question: I am on 20mg of Lipitor since 7/2000 with great results and no side affects yet. I have read all the FAQ's.
I have three more questions:
1. What are the CPK and Liver tests checking, and how often should they be done?
2. Should I try 10mg tabs? On 20 mg I dropped from 220 to 155. LDL/HDL are also well within limits on the 20mg. Will a reduction to 10mg reduce potential for side affects?
3. What are the usual GI symptoms with Lipitor. I seem to be constipated, even with Metamusil daily. No other know affects at this point. Maybe headaches more frequent, but I had these before I went on Lipitor.

Answer: Liver function tests are usually done every 4 months for the first year and then every 6 months for a year or two then every year. If the dosage is increased or you are taking other potentially hepatotoxic drugs then every 4-6 depending on the risk. CPK is usually tested at the first test only or with muscle pain. 10 mg is worth checking since the risk is smaller. Most patients do not experience constipation, but easily checked by stopping it for a week. Having said that a small price(easily fixed) for the results you are getting.

[posted 09/21/2000]
Question: I have been taking Lipitor for a couple of years along with gemfibrozile (Lopid).
For approximately the last six months, the bicep muscles have been sore as if I had
exercised them, especially when I wake up or move my arms up to the side, for example,
when lifting my purse from the passenger side when getting out of the car.
Or when moving my arm back quickly. If this is a side effect of Lipitor, what
could happen if this pain is ignored? should I go back to Mevacor?

Answer: Maybe, have your md check a cpk. If that is high, clearly the medications, but may be the medications if normal. I'd stop the medications until you know-this will also give you a couple of weeks to see if the problem goes away. If not, then it is not the medication. Mevaclor will probably have the same problem.

[posted 09/12/2000]
Question: I am currently taking 10mg of Lipitor and plan on starting a family. Are there any side-effects associated with Lipitor that would reduce my sperm count or affect my sperm development so as to possibly cause birth defects?

Answer: No.

[posted 09/15/2000]
Question: Last year I was diagnosed with mild Mitralvalve Prolapse (is there such a thing as mild?). Subsequent blood analysis discovered high cholesterol (254) of which I was put on Lipitor (10 mg) since 02/00. I've read about the two major side effect symptoms that affect a small percentage of people muscular inflammation and elevated CPK (what is CPK?). On my next scheduled visit to my physician I'm going to ask to have my CPK checked.
Question: 1) What effect does lipitor have on the heart since the heart is also muscle.
2) Since on Lipitor and maintaining a conscious low cholesterol diet, my cholesterol has gone to 145 what effect will temporarily stopping lipitor have or to put another way, what effect does starting/stopping have on the
liver?
3) I hadn't realize that I shouldn't be taking niacin with lipitor. The niacin (20mg) came in the form of multivitamin (Centrium) tablets. Why or what's the harm in taking both ?)
4) Is it somewhat normal to experience muscle aches, various parts of my body, after being on lipitor over 3 months?
Thanks for the advice...

Answer: 1)Mitral valve prolapse varies a lot in severity. This is usually measured by the amount of regurgitant flow back through the valve(measured by echo) and for minimal regurgitation we don't even recommend dental antibiotics. Severe cases can result in valve replacement, but that is unusual. 2)Lipitor works the day you take it. Once you stop it, the enzyme in your liver that is responsible for making cholesterol is working at full speed again and the cholesterol factory in your liver starts back up. The liver toxicity effect of lipitor is small in small dosing, but not zero. If your liver function tests are ok, there is probably no effect at all. 3) This is a pretty small dosage of niacin, but they do have additive liver toxicity and should be avoided unless monitored closely by an md. 4)The muscle aches depend on the severity, if really severe would justify a halt for a couple of weeks to see if they are caused by the lipitor. You can have muscle pains without an elevated cpk that goes away after stopping the lipitor. Usually, the cpk is elevated.

[posted 08/20/2000]
Question: I'm on Lipitor 10mg/day since early this year or late last year. I've had two blood tests, spaced about 6 months apart, each of which found tc down from 260 to 200 and hdl maintained as before at 75. My doctor informed me on both occasions that liver function was "perfectly normal," nevertheless I seem to tire more easily and have odd muscle pains at various sites. Is there a -particular- liver function test for this situation that perhaps my doctor failed to request? I am not sure what I am seeing on the first lab report (2nd not yet forwarded to me). The section marked "Liver Panel II" shows 'normal' results for Total Protein, Albumin, Globulin, Bilirubin, Alkaline Phosphatase, GCT, AST, ALT, and LD.

My doctor seems competent, and he told me in passing that he had to discontinue Lipitor for two of his patients, which indicates he knows what he's looking for in these tests. Nevertheless I'd feel somewhat better knowing the muscle aches are related to exercise or other innocent reason, rather than unrecognized liver damage.

Answer: A cpk would be the test you are interested in. This is a muscle enzyme and usually up with lipitor associated myositis. But, I have had at least two patients who have had muscle pain and normal cpk-but the pains cleared with stopping the lipitor. So, a 2 week trial of stopping is usually the only absolute way of knowing. If the pain improves and returns with restarting the lipitor-that is probably the problem.

[posted 08/19/2000]
Question: i HAVE CHOLESTROL LEVEL OF 240 WITH HIGH LDL AND NORMAL HDL. MY DOCTOR PUT ME ON LIPITOR WHICH AFTER 30 DAYS WAS GIVING ME HORRIBLE PAINS AND ACHES, THEN ZOCOR WHICH GAVE ME HEADACHES AFTER A WEEK A DN THEN PRAVICAL WHICH GAVE ME PAINS IN MY REAR RIGHT BACK. WHAT IS A PERSON TO DO? WHAT SHOULD I DO NEXT. I REALIZE THAT THE STATIN DRUGS HELP A LARGE AMOUNT OF OTHER POTENTIAL PROBLEMS IN ADDITION TO CHOLESTROL LOWERING. SHOULD I TRY BAVOCOL AND ANY OTHER ST ATINS OR TRY SOMETHING ELSO AND IF SOMETHING ELSO, WHAT? THANK YOU FOR YOUR HELP.

Answer: If one gives you trouble, usually they all do. Try lopid or triclor next and if that fails questran.

[posted 07/21/2000]
Question: For about years I was taking Zocor 10mg and getting a liver function test about every three months,we moved to a new area and my new doctor put me on liptor 20mg I get a liver function now only once a year. My last test my liver function was elevated in the high normal range,one,I don't know which one is about 3 points over normal.I spoke to the doctor about taking less before we had the results of the test and he thought that the 20mg was ok.He said all the other tests were ok,but did not say what my cholesterol count was. Iam concerned that this dose might be to high,I sometimes have a beer with my dinner but that is all the alchol I drink, thank you

Answer: The alcohol is ok, not checking your liver regularly is not. Insist on more frequent testing, at least every six months and more frequently if they are elevated as they are currently.

[posted 07/21/2000]
Question: Subject: Lamisil side effect as an indicator of side efect from Lipitor.

About 18 months ago I was prescribed a course of Lamisil for a fungal infection of the toenails. We had tried several other treatments for some time without success.

The Lamisil was very effective. I stopped taking the drug early as I suffered from moderate to severe loss of taste (My sypmtoms concurred exactly with your patient "Lamisil and loss of taste [posted 1/5/99]"). It took several weeks for the symptoms to disappear.

The same doctor that prescribed the Lamisil has now prescribed Lipitor for elevated cholesterol (Australian measure=9.4, which I think equates to 366 mg/dl). Hehad blood test results for liver function prior to prescribing the Lipitor and I am comfortable with the recommdation of Lipitor, but I am concerned with any possible side effects.

Specifically, if the loss of taste resulted from a side effect of Lamisil on the liver, is it likely that Lipitor will also effect my liver? Is it likely that the Lamisil damaged my liver and Lipitor will exacerbate the damage, or would my recent blood tests have shown up any damage done 18 months ago?

Answer: Possible, but unlikely. You will need to do regular liver function tests and stop the lipitor with any rise.Do these at one,three,six, nine months after starting the medication to watch them closely.

[posted 07/11/2000]
Question: My Dr. has me on 40 mg. of Lipitor, up from 20, and I drink about 8 beers a night. This isn't good I know but is it going to kill me? I also have very bad bouts of stiff neck but this could be just stress of caring for my Mother who is living with me and has Alzheimers. Any input would be greatly appreciated.

Answer: Keep an eye on your liver functions if they are ok, then there is no obvious risk.

[posted 07/3/2000]
Question: Will my cholesterol return to its former level after I stop taking Lipitor? After many years of struggling with marginally high chlolesterol and having limited success with diet and exercise, my doctor put me on 10mg/day of Lipitor. Improvement was dramatic after 4 months: Total Cholesterol dropped from 282 to 131. LDL dropped from 183 to 86. My doctor suggested I stop taking the Lipitor but I talked him into letting me stay on it another three months. If I stop taking it, won't my cholesterol simply return to its previous high level?

Why should I stop taking Lipitor?

Answer: It will unless you have lost a lot of weight. You seem to have more medical sense than your md. The only reason to stop would be some side effect or toxicity of the liver, etc.

[posted 07/1/2000]
Question: I have been taking Lipitor for several years. It is the only medication I take. I have been getting Migraine type headaches with increasing frequency...almost daily now.
Is there a possibility that this is a side effect from Lipitor?

Answer: Probably not, but a change in frequency or severity of a headache needs to be discussed with your md.

[posted 06/14/2000]
Question: Does lipitor have an effect on you after taking asprin?

Answer: Not usually.

[posted 06/11/2000]
Question: I have been on Lipitor for approximately a year and have reduced my high cholestrol levels from 310 to 230, not good yet but quite an improvement. Last week my doctor increased my dossage to 40 mg daily and within days I developed urinary problems, having to "go" as often as every 45 minuites. I noticed on another site that this might be a side effect. Do you have any helpful information on this?

Answer: Cut it back to 20 mg and see if it persists, but I doubt it is due to the medication. That is because you had no side effects at 20 mg.

[posted 06/7/2000]
Question: after taking lipotor had sever muscle pain continues to bother me even after stopping use does problem go away or can muscle pain continue

Answer: It usually stops, but may take a couple of weeks. Did you get a cpk level? This is a muscle enzyme usually up in the inflammation caused by this class of drugs. If it is normal, look for another cause.

[posted 06/10/2000]
Question: I have high cholesterol and have been on Lipitor for several years. I had leg pain sometimes at night and when that happens I stop taking the Lipitor for a few weeks, then I go back on it and I don't have the problem again for awhile. A more recent problem was my last check up at the optomitrist. In less than a year my eyesight (which was on a platau for a couple of years) has worsened dramatically. My optomitrist sent me to my family physician suspecting possibly diabetes. Those test came back fine. No diabetes or anything else that could attribute to the problem showed up on the results of those test. I stopped taking the Lipitor, and my blurred vision improved. Do people taking Lipitor have visiion difficulties?
I started taking the Lipitor 2 days ago and my vision is blurred again.

Answer: Not usually a problem and if it was going to be so, why didn't it start several years ago?

[posted 06/1/2000]
Question: Could Lipitor be causing my urine to be bright yellow?
And I am not taking any Vitamins.

Answer: Not a usual problem.

[posted 05/30/2000]
Question: I'm using Lipitor 20mg1xdaily for the first time and have no reactions. However I'm also taking weight loss product: METAB-O-LITE, 2tables 3times daily and the following: [Glucosamine500mg&Chondotin400mg 3tabs x daily], [Vit. E 400mg 1tab daily], [Lecithin 400mg 1xdaily], [Vit. C 500mg x1daily], [Ginkgo Biloba 2xdaily], [Garlic 650mg 1xdaily], [Citracal 1xdaily], and [Sentury-Vite multi 1xdaily]
I'm hoping that all this is ok with Lipitor. Thank you

Answer: Should be, but keep an eye on your liver functions. These should be checked every 3-4 months for the first year and then every 6 months after that.

[posted 05/26/2000]
Question: my daughter is 5 years old (turing 6 in december) she has just been tested and has a cholesterol of 12.
the doctor presibed lipitor 10 mg (i'm using the same drug), what is the side affects of lipitor on young children?

Answer: Not known and highly debated as to who should be treated at this age. This would depend markedly on whether there is a family history of vascular/cardiac disease. Get a second opinion.

[posted 05/22/2000]
Question: i have been on lipitor for 3 years, recently my doctor put me on 80 mg for six weeks, i noticed my stool was yellow, he says my liver was ok, that the 80 mg did not help much, and lowered me t 40 mg. should i be concerned, change doctor? ive been off 80 mg for 3 weeks, still yellow. do you think the 80 mg damaged my liver? or what could this yellow be?

Answer: If it is the Lipitor, you would have an elevated bilirubin or elevated liver function tests or both. Ensure these have been checked. If normal, it is not the Lipitor.

[posted 05/21/2000]
Question: Iam taking 10mg lipitor pills and I have been dizzy headed and my vision has become blured is this normal with the drug?

Answer: Very unusual.

[posted 05/22/2000]
Question: I started taking Lipitor on 5/8/00. Since that time I have been experiencing severe constipation as well as gas daily. Large amounts of fruit/bran and water do not seem to help the situation. What other medications are available in controlling high cholesterol without these side effects? Why does this drug cause these problems?

Answer: This is a little more severe than usual, but everyone is individual as it pertains to drug interactions. Triclor, Lopid would be the next try or one of the other HMG CoA Reductase drugs like Pravachol.

[posted 05/19/2000]
Question: My druggist says not to drink grapefruit juice when taking Lipitor.
Why is this?
Back in January 1999 - you answered a similar question saying you hadn't heard that this was the case with Lipitor. Anything new on this front??

Answer: It does appear to change the P450 system and reduce the effectiveness of this class of drugs. Probably to be avoided.

[posted 05/14/2000]
Question: I have a P.S.A. level of 22.48, which is high for a 49 year old. After 3 biopsies showing no cancer within the past year, the doctor has put me under a watch and see approach. I am curious about Liptor causing a high P.S.A. level. How long should I stop taking Lipitor to see if this indeed affects my P.S.A.? My Cholesterol at the higest was 256 and now at 134. I exersise regularly and eat right with no weight problem.

Answer: I have never heard of this being a problem and would strongly doubt any interaction. But, it would be easy to stop for 6 weeks or so and see.

[posted 05/15/2000]
Question: If I take lipitor after dinner at night, can I drink grapefruit juice in the morning? Where does the cholesterol go that is prevented from going into the bloodstream? I know I have some gallstones - will using lipitor aggrevate the condition?

Answer: Lipitor works by slowing the metabolic pathway that is responsible for making the cholesterol. So, there is no "dam" or spillage into the blood, it just isn't made in the first place. There should be no affect that I am aware of on gallstones. Grapefruit juice is supposed to change the p-450 metabolic pathway, so the time that you take it is not the major issue, although there are some drugs that are slowed in absorption with taking grapefruit juice.

[posted 04/17/2000]
Question: In May, 1999 I was diagnosed with Type 2 Diabetes and high cholesterol. Since my blood sugar wasn't terribly bad my doctor & I decided to see if we could control it by diet. At the same time, my doctor prescribed 20mg of Lipitor daily. Both my blood sugar (below 140 first thing in the morning and approximately 2 hours after a meal) and cholesterol came down, but after approximately 9 months the cholesterol started to rise. My doctor then increased the Lipitor to 40mg. I have been taking the 40mg for about 2 months and have noticed that my blood sugar has gone up significantly (170 to 210) even though my diet has remained consistent. Has this been found to happen in others? I tried 1 week of reducing the Lipitor to 20mg and the blood sugar level started to come down 20-30 points. I went back to the 40 mg and the blood sugar rose again.

Answer: No, I suspect the rise in your cholesterol is caused by the rise in blood sugar, not the other way around. But, easy to try a different class of cholesterol medication(Lopid,Triclor for example) for a couple of months and see.

[posted 04/12/2000]
Question: during a short vacation in aruba, i suddenly felt like millions of ants were crawling all over my skin-there was no rash on my body, just the most uncomfortable pain all over my skin-my doctor thinks this is a reaction from the lipotur-why all of a sudden and do you agree?

Answer: Sounds uncommon for lipitor. More like a sun sensitivity, but hard to know with this short a history.

[posted 04/20/2000]
Question: Lipitor (10 mg)has just been prescribe to treat my high cholestrol.
I am also currently taking the oral contraceptive Mircette. What if
any interactions should I be concerned about?

Answer: Shouldn't be any. Liver functions need to be followed, but that would be the case with or without the Mircette.

[posted 04/15/2000]
Question: Why do you have to take "Lipitor" at bedtime? May I choose a more convenient time for me?

Answer: Cholesterol metabolism rises during the evening and early am hours. So, the highest levels of Lipitor will occur during the night during highest production by the liver. However, in fact I rarely see any clinical difference. Take the Lipitor at night until your next blood test and then take in whenever you wish and see for yourself.

[posted 04/4/2000]
Question: I have been taking 10mg of Lipitor






every other day for 4 months and it did a wonderful job of lowering my cholestoral counts. But for the last month I have been unable to sleep without a sleeping aid. Can Lipitor cause insomnia?

Answer: Not usually.

[posted 04/7/2000]
Question: Dear sir or madam,
I am on lipitor and I just have a few questions for you.Are muscle pains and weakness 2 side effects of lipitor?Can lipitor cause trouble walking and moving without muscle pain? Can this condition cause permanent damage or be debilitating?If so what treatment options ,if any, besides taking me off of lipitor are there?And how long could recovery from this take? Thanks again,Iren

Answer: Muscle inflammation occurs in about 1-2% of patients and is easily checked by a serum CPK level(a muscle enzyme which is released with inflammation). Weakness is not usually seen unless the CPK is high, ditto muscle pain. However, if you are experiencing pain and muscle problems, this is usually a contraindication to taking the drug and should be discussed with your md asap. It is usually not permanent if stopped, I have not seen patients who have taken it long term with this problem since it violates common medical sense. There are no options if this is the problem except stopping the medication.

[posted 04/6/2000]
Question: I have been taking Lipitor 10 mg OD for a little over one year. Before I started taking this medication I was Able to exercise by walking an hour a day. Two months after starting Lipitor I developed severe pain in my left knee and some muscle pain in my neck and legs. After two months I was diagnosed with Avascular necrosis of the left knee. It took over 6 months to heal and I was able to start my walking again in January. After two months I am again experiencing the same pain in my right knee. I thought this was odd as there were no injuries to my knees or other diseases present that would cause this condition. I stopped taking the Lipitor about five days ago and the pain is greatly decreased in the knee and I have no other muscle pain. Could this be related to the Lipitor? My Cholesterol level is normally 200 so I don't think going off this medication will harm me.

Answer: Not a problem that I'm aware of, but sounds causal, your md should file an adverse drug reaction form. Try Triclor or Lopid next.

[posted 03/30/2000]
Question: I am taking Lipitor. Is there any adverse affects to take with it ginko baloba, vitamin E?
My doctor said I should not eat grapefruit, is this recommended by the drug manufacturer?

Answer: Grapefruit is not currently recommended due to its theorectical effect on the cytochrome p450 system. But, clinically hard to know if it matters. The other supplements should not be a problem.

[posted 03/27/2000]
Question: 1) Several patients have mentioned or inquiried, in your forum, about lipitor and sex drive. When asked if Lipitor decreases libido in men, the answer is always "not usually", which means that sometimes it IS! But how often IS it? occasionally? Rarely?
2) I noticed that many patients who wrote in with questions about lipitor were also taking zoloft or some other antidepressant. I'm curious about the relationship there? which came first?
I had noticed a greatly decreased sex drive and sexual responsivity pattern about 6 weeks into taking 10mg. lipitor, but the doctor thought I might just be depressed. He wants to try me on Serzone. He did not even consider the possibility of Lipitor side-effects.

Answer: Well, pretty easy to stop the Lipitor for a couple of weeks and see. I have about 1% of men who have decreased/absent erections on this medication. Not common, but clearly related.

[posted 04/1/2000]
Question: After taking lipitor for about 8 months, I developed gout. A friend's mother had the same thing happen. Is there a connection? By the way I do have about 1/2 bottle of wine with dinner.

Answer: No connection between the lipitor and gout. But, people who are overweight tend to have high cholesterol and high uric acid levels(the cause of gout).

[posted 03/31/2000]
Question: After 15 years of elevated LDL levels [> 170], I finally heeded my doctor's advice and started taking 10mg of Zocor daily in 2/99. Tests done in 5/99 indicated lower cholesterol [Total=201 HDL=40 LDL=132] and normal liver function [ALT=41 AST=28]. In 1/00, I was forced to switch to 10mg Lipitor because HMO Blue of Massachusetts dropped coverage for Zocor. Tests done last week after 3 months on Lipitor indicated a further reduction in cholesterol [Total=162 HDL=34 LDL=93], however liver enzymes were elevated [ALT=78 AST=39]. I would appreciate any input regarding these alternatives: 1) have my doctor write a letter of medical necessity to HMO Blue to get coverage for Zocor 2) Cut the Lipitor in half so I'm only taking 5mg daily and then have cholesterol/liver function retested in a couple of months.

Answer: Probably not the Lipitor at this dosage, but could be. Most mds would either stop the Lipitor and restart it when your liver functions return to normal (then if they rise know it is the Lipitor) or keep on the Lipitor until they continue to rise since these are minimal elevations. For my patients on the class of drugs, I have only had a couple with liver problems at this dosage. Usually, the elevation is due to another cause(of which they are lots since the liver is very sensitive to infections of all sorts).

[posted 03/23/2000]
Question: I have been treated for high cholesterol for a number of years, and had CABG 18 months ago. Since surgery I have adopted a rigorous exercise routine, working out 6-7 days per week for over an hour, including 30+ minutes treadmill at maximum elevation and 4.5mph. I am careful about diet, but not compulsive. I am 5'10", 205 lbs, with 14% body fat.
My cholesterol is still high (228 recently), unless I am on lipitor or pravachol both of which have been extremely effective. I have repeatedly tried to stop these medications because of loss of libido and e-d. Is there a
medication of this type that is less likely to cause these problems? If I reduce my pravachol (20mg) to 10 mg would this help? Can it be taken on alternate days, (or alternate weeks, or alternate months) to achieve cholesterol management without impacting my sex life?

Answer: Try Triclor or Lopid. If these do not work, Questran for your cholesterol. I have about 3 patients with a similar problem.

[posted 03/19/2000]
Question: I have been put on 80 mg of Lipitor. My cholesterol is 243, hdl is 32.5 and ldl@131. The dosage seems high. What is your opinion.

Answer: Most would start at 10mg and increase it as necessary. This is a whopping dose.

[posted 03/20/2000]
Question: IAM CURRENTLY TAKING ZESRTIL 5MG. TO CONTROL HYPERTENSION. I HAVE A FAMILY HISTORY OF HEART DISEASE. MY TOTAL COLESTHEROL HAS HOVERED AROUND 275-298 FOR THE LAST FEW YEARS, WITH LDL OF 198-225. MY DOCTOR HAS RECOMMENDED LIPITOR TO REDUCE LDL. MY LIVER EZYMES HOWEVER HAVE ALSO BEEN ELEVATED FOR THE LAST YEAR(ALT 198-218). MY CONCERN IS THAT ALL THE INFORMATION THAT I HAVE GATHERED INDICATES THAT LIPITOR AFFECTS LIVER ENZYMES. MY DR. FEELS THAT IF THE CHOLESTHEROL GOES DOWN THE LIVER ENZYMES MAY BECOME NORMAL. I HAVE NOT FOUND ANY INFORMATION THAT INDICATES ANYTHING BUT NEGATIVE AFFECTS TO LIVER FUNTION FROM LIPITOR. I AM WONDERING IF LIPITOR MIGHT MAKE THE OVERALL SITUATION WORSE?

Answer: First, see a gi specialist to find the cause of this elevation. It probably is "fatty liver" but, you need to look for other causes. The lipitor will not lower the liver functions. But, in general they do not get worse. This would have to be monitored, but should be one of the questions you have for your gi specialist after an evaluation of the elevated enzymes is done. While you are having this done, start on something like questran. This is a binding resin that is not absorbed and has no effect on your liver. It is limited by gas/cramps/gi problems but, will not affect your liver while you are getting your evaluation.

[posted 03/16/2000]
Question: Is there any validity to the report that you should not take St. John's Wort while taking Lipitor?

Answer: You can take it, but it may effect the metabolism of the drug. However, your md will need to adjust the lipitor to get the desired level of cholesterol anyway. Clinically, it isn't usually a problem.

[posted 03/18/2000]
Question: I AM SOMEWHAT A SNORER. I HAVE NO PROBLEM GOING TO OR STAYING A SLEEP. IN THE PAST MONTH MY HUSBAND SAYS IT HAS GOTTEN WORSE. I HAVE STARTED TAKING LIPITOR, COULD THIS HAVE ANY CONNECTION? A FEW YEARS AGO I WAS OPERATED ON FOR A DEVEATED SEPTRUM AND I DON'T HAVE MUCH SINUS PROBLEMS.
aNY SUGGESTIONS?

Answer: Not probably, usually weight gain will be the culprit. Ask your husband if you stop snoring, this is called sleep apnea and may need to be evaluated by a sleep specialist. Let your md know if you do stop, especially if you have a lot of daytime fatigue/uncontrolled sleepiness-very indicative of sleep apnea.

[posted 03/12/2000]
Question: I too just started taking Lipitor. Total cholesterol was good however HDL/LDL ratio was not.

As soon as I started taking Lipitor I had pains in my upper chest area that I thought was a heart attack. A follow-up treadmill stress test showed no problems. A friend said he ended up in the E.R. because he thought his breast-area pains was an indication of a heart attack. His heart was fine. His doctor switched him to Pravachol and the pains stopped.

I think I'm in that 1% that has muscle pains and/or G.I. problems with Lipitor. Are physicians running into more patients with this complaint about Lipitor?

Answer: Not usually, the muscle pains are usually systemic,not isolated to the chest. Usually, the problems are pretty similar between the two drugs.

[posted 03/10/2000]
Question: I have been taking 20 mg,once a day, of Lipitor since about
Dec.of last year. My coordination has suffered since then. Could it be the taking of the Lipitor that is causing this?
I'm thinking of going back to Zocor. Would you recommend this?

Answer: I doubt it, but it wouldn't do any harm to stop it for 6-8 weeks and see. The zocor is a similar medication and going to it would be ok also.

[posted 03/6/2000]
Question: Can Lipitor be taken with antibiotics such as Cipro? Also, I was recently diagnosed w/multiple thyroid goiters and would like to know if Lipitor can effect thyroid function? Can Lipitor be taken w/multi-vitamins and herbal supplements? Can it be taken w/metabolife products?

Answer: No obvious connection or problem between Lipitor and Cipro. Lipitor should not affect thyroid function and can be taken with vitamins and supplements, including metabolife products.

[posted 02/28/2000]
Question: I am taking lipitor for high cholesterol. I have been told not to drink grapefruit juice. Does tis mean I cannot eat grapefruit in any form.

Answer: Hard to know, I tell people to limit the intake-that is not daily amounts and watch the cholesterol. Since grapefruit induces the p450 system, it increase the lipitors degradation, hence lowering its effect. But, occasional use should not do this.

[posted 02/27/2000]
Question: I have very High Cholesterol (started @ 427 two years ago, now at 290). My doctor has had me taking Lipitor for 2 years now, I started at 10mg and was quickly moved up to 20mg then 40mg per day. Three months ago I was boosted up to 80mg. At that time my doctor told me this was a high dosage not recommended to be given for more than three month. Yesterday my blood work came back and he told me he wanted to keep me at 80mg and add another medication that I would take twice a day. My question is, "Is there a dangerous level point in the amount of Lipitor taken daily and does this sound as if I should be seeking a second opinion?"

Answer: No, as long as your liver functions are ok. Usually, we combine it with Questran which is a binding resin to avoid additional liver toxicity. But, you can use Lopid or Triclor as long as you watch the liver functions very closely. Also, ensure your thyroid has been checked and that you don't have early diabetes mellitus(both causes of elevated cholesterol which are treated differently).

[posted 03/3/2000]
Question: I am currently taking 10mg of Lipitor a day. I also suffer
from Springtime allergies. Is it safe to take Claritin D
while I am taking Lipitor?

Answer: No problem.

[posted 03/2/2000]
Question: I suffer from occasional insomnia and increasingly frequent head and neck pain, 90% of the time on rising, since I started taking Lipitor. When I get into cycles of poor/sleep and daily occipital[ain, I end-up taking excedrin (500mg x1) with Gavascon as I also have acid reflux when taking aspirin. But - the combination of a stimulant with the aspirin and acetainphen is the only thing I've found that gets rid of these headaches. I used to get frontal migraine headaches (unttil my mid-twenties) and this pain is almost as bad and nearly as intractable. It can take hours to go away. I have now stopped taking the lipitor three times when the headache/insomnia cycles started getting out-of-hand. I get almost immediate relief -and generally stay off Lipitor for a week. When I resume taking the Lipitor again, the head/neck pain cycles resume in about 3-4 weeks. I have not had my liver enzymes rechecked since I started taking the drug (my HMO doesn't go out of its way to encourage this). I get a very good cholsetrol response (from 270 down to 170 or lower). Problem is, I feel like a wreck half the time. The only other provacation ( Ihave found) that causes a similar response is drinking as little as one beer in the evening, or consuming one or two glasses of wine. Any more alcohol than that is a dead certainty to cause the head/neck pain -so I stay away. Are these related? I feel I don't get much sympathy or any advice on other therapies now that I don't have classical migraine. It's 'just a headache.' But as someone whose had headache pain their whole life (in one form and another) these are doozies. I have used orthopaedic pillows, and exercise regimes - which help. But since I started the Lipitor, they don't seem to work as they used to.

Answer: Well, there are other options for your cholesterol. First try the other HMG Co A Reductase drugs like zocor, if these cause problems, I'd try Lopid next although some would use Questran. Many types of migraines are initiated with alcohol, especially the subgroup called cluster migraines.

[posted 02/28/2000]
Question: I have been prescribed Lipitor. Before it was prescribed I took a multivitamin, a zinc tablet and a vitamin E tablet. Can I still take these supplements while taking Lipitor?

Answer: No problem.

[posted 02/6/2000]
Question: Can either lipitor, and or zyrtec cause a drug side affect that
pertains to tinnutis(ringing sound in the ear)? This just atarted
about a week ago, with congestion in the ear,2 days later the
congestion was gone, then the ringing sound showed up for a couple
of days, it was gone for a day, & has come back again for 4 days,
with no let up, so I was wondering if these 2 drugs together,could
cause this side afffect. I stopped the zyrtec the noise didn't go away,
I then stopped the lipitor for a day & the sound went away. Have to stay on lipitor
until my next bloodtest, so I can't really stop the drug just yet o see if the sound
will go away permanently. Just wondering if there is any drug
interactions orside affects pertaining to this.
Thanks

Answer: Not a usual problem, but easy to check by stopping the medications for a week. If you restart the lipitor and it restarts and stops on discontinuation-probably the lipitor.

[posted 02/11/2000]
Question: I am taking Lipitor 10mg: I notice from your FAQ board that it is more effective at night. Should I be taking my daily does in the evening as opposed to the morning. Also notice that my urine is quite dark although i drink plenty of water: should I ask my doctor for a renal test. Thank you for your advice.

Answer: Theorectically they work best when taken at night since your cholesterol metabolism is highest at night. In practice, I don't see a big difference. As to the urine, doubt there is any problem here unless you are seeing bilirubin from your liver-check with your md.

[posted 02/11/2000]
Question: My mom has been on Lipitor for a few months now. She was 54 years 'young' until she started on this drug...now she can't sleep, is constantly fatigued, is weak and achy in every muscle and joint, is immediately nauseated following eating and gets severe indigestion...she feels like she's always just on the verge of getting the flu, but it never materializes. She is in the middle of doing the liver function testing and has stopped taking the drug in the meantime. If there is a problem with her liver caused by this drug, will it rectify once stopped or titred? Other than titring or trying other drugs in the same class, what drug would be preferable, given the number and severity of side effects she has experienced with this drug?

Answer: It would depend a great deal on the tests. If her liver functions are elevated or her CPK(muscle enzyme) then any drug from this class will probably have similar effects. Other options would be a binding resin(works but a gi nuisance for many) or lopid. Most would try the lopid/triclor. These drugs can affect the liver but by a different mechanism.

[posted 02/4/2000]
Question: I was diagnosed with Familial Hypercholesterolemia in 1996. At that time my level was 11.3 and I was prescribed Zocor. After 3 months there was very little difference and my dosage was increased to 40mg which, after 9 months, brought my level down to 7.0. During this time I found I suffered frequent joint pains and headaches and eventually towards the end of 1997 I stopped taking the drug.

In 1998 I was called to my Doctors to have a test which resulted in a level of 11.0. I don't know how this level is made up as we don't seem to be given the same degree of information by our doctors in England that I see in the questions on the FAQ pages. I was finally persuaded by my doctor in September of last year to start taking Lipitor (10mg). Having just had a test (Jan 2000) it is clear the results are far greater than with Zocor, my level is now 6.8, and my doctor has now increased my dosage to 20mg to improve the level further.

I am however suffering various side effects again including dizziness, stomach upsets, headaches, cold/numb fingers and toes and cramps/pains in arms, legs and chest. My own doctor seems to know little about the side-effects and the FAQ sheet has to date been far more useful.

Are there any other ways of treating the familial form of high cholesterol? I am being told I have to take these drugs for the rest of my life which is not something I feel I can tolerate while the side-effects are so severe.

Any advice you can offer would be much appreciated. Thank You.

Answer: Sounds like the best option is to use a small dosage of Lipitor with other cholesterol lowering agents. Oral binding resins would be the best, since they have no systemic side effects. Their side effects are all gi. That is gas, constipation, cramping and bulky stools. Questran is what is used in the U.S. primarily and any volume of this can be taken without any systemic side effects. But, a small dosage of lipitor 5 or 10 mg with the binding resin would be the next option. Ensure that your md has checked your serum CPK level to ensure that you are not one of the 1% that gets muscle inflammation with the HMG Co A drugs(like Lipitor). This is a relative contraindication to using the drug.

[posted 02/3/2000]
Question: After 3 months on Lipitor I developed severe nausea and muscle tingling and weakness . I stopped Lipitor . Cpk was at high end of normal range and went to midrange a month latter . Extensive tests ruled out just about everything except reaction to Lipitor . After 8 months I'm improved but still have muscle weakness and mild nausea . Did I do permanent damage or will the neuropathy slowly resolve ?

Answer: I don't hear any evidence of a neuropathy. The HMG Co A Reductase drugs can cause a myopathy, not a neuropathy. This should be returned to normal by 3 months, look for another reason for your problem.

[posted 01/20/2000]
Question: My husband has been taking Lipitor for over a year. He also takes a multivitamin, Vitamin B complex, and ginsing. He recently heard somewhere that there is an interaction with Lipitor and vitamin B. Have you heard about this? Should he stop taking extra vitamin B?

Thanks

Answer: None that I'm aware of.

[posted 01/17/2000]
Question: I have been taking 10mg Lipitor for about one month and have noticed a frequently heavy heart beat, not necessarily rapid (approximately 80 bpm as opposed to a resting 72 bpm), accompanied by a slight light headedness. Could this be related to the lipitor? If not, is this something I should be concerned about?

Answer: Not usually the lipitor.

[posted 01/18/2000]
Question: I have just started the lipitor. My feet have been burning lately.
Recently it seems to be travelling to my arms also. I was wondering
about drug interactions and if this could be the cause.
What other things can cause this symptons.
Thak you
yours truly
Sylvia reaume

Answer: Burning feet are most commonly due to a peripheral neuropathy. This is damage to the nerve endings in your feet(the longest nerves in the body and the first affected). Possibly the lipitor, but would be very unusual. Easy to check by stopping it while you are getting the burning looked into. This will require a visit to your doctor.

[posted 01/12/2000]
Question: I was recently increased to Lipitor 20mg. I use an aloe based lotion & have a red-flushed face.
I have heard of others with pioson ivy-like symptoms. Any comments?
Also, is it OK to take a multi-enzyme with Lipitor? ( I also take Lycopene, Vitamin E, and Folic Acid with occasional Zinc))

Answer: Rashes are possible, but very infrequent. There should be no problem with the Vitamin E and Folic Acid. I'm not familiar with any problem with lycopene, but out of my turf.

[posted 01/11/2000]
Question: I am writing for a friend. He is 70 years old with high cholesterol (probably genetic).
His doctor wants him to go on Lipitor. His question is: Does the body become dependent on having
the Lipitor perform cholesterol lowering functions? If he decides to go off later would his body have difficulty re-adjusting?
Thank you.

Answer: The medication works by inhibiting the enzyme in the liver responsible for your own cholesterol metabolism. Once the drug is not present, the enzyme goes back to work and your cholesterol level rises to its previous level. The body has no dependency associated with this type of action. If he stops it, he will have no appreciable change in the way he feels. But, his cholesterol will again be high.

[posted 09/23/1999]
Question: My physician has prescribed lipitor for arterial calcification
noted during a CT scan of my lungs. I do not have above normal
LDL or HDL levels, but have had Type I diabetes for 35 years,
had an early menopause, and had no hormone replacement until I
began taking Evista last December. His nurse called me after the
CT scan with the instructions to begin lipitor which, she said,
"is the latest thing," "has no more adverse effects than
aspirin or Tylenol," and "will coat my arteries with some protective
substance," and that it is used even in the absence of hypercholestremia.
The internet has provided information about adverse effects and contra-
indications. Please provide me with some real information about the
use, action, and benefits of lipitor in the treatment of arterial
disease when hypercholestremia is not present.

Answer: There are several studies of treatment of cholesterol in different other medical conditions. Generally, they have focused on patients with coronary disease. There are variations to watch graft patency after bypass and to treat patients with known angina to avoid progression to a bypass. In general, we try to keep cholesterol levels as low as possible if there are other ongoing medical problems, such as Diabetes Mellitus, with the documentation of atherosclerosis. No one is clear about the optimum amount of lowering in certain situations. It seems that getting a LDL below 100 achieves the maximum benefit, and further lowering is of less effect. So, I'd need to know your LDL. But, many physicians are lowering these below 100 in patients with other medical risk factors. It will not "coat " your arteries, but lower the cholesterol. It does have toxicity that will need to be monitored.

[posted 09/10/1999]
Question: My doctor said my cholesterol reading is 253, HDL is 50, LDL is 170, Trig. are 164. He wants to talk to be about prescribing a drug to lower it. Do the above stats indicate me as a candidate? I am a non-smoker, have a glass of wine occasionally and am healthy otherwise (l46 lbs). I have tried diet and exercise, but the number is still going up. Also, upon searching the Net, I think Lipitor is a good one--are all the "statins" pretty much the same? Will I have to take the drug the rest of my life? My appt. is the 21st of Sept., and would like to hear from you before then. Thank you. Jo

Answer: Lipitor is currently the most efficient, but in reality, they don't matter a lot as long as your cholesterol reaches target. Target is usually an LDL below 160, although many physicians shoot for 130. This would depend on age(over 50), sex(male), and family history which I do not have. Balanced against this is the fact that your HDL is ok, not great. I'd probably recommend a medication if the diet hasn't worked, but a small dose like 5 mg of Lipitor to start.

[posted 12/1/1999]
Question: I have been taking lipitor for about 3 months. My cholesterol level droped from 304 to 232. When if first began taking the medication, I didn't have any problems, but now I am having a problem with pain in the lower left side of my back. If I drink anything other than water, my lower back starts to hurt. Can the lipitor be causing this? thanks

Answer: Probably not, especially if your liver function tests are ok. Sounds like it is in your kidney, call your md for a urine check.

[posted 12/1/1999]
Question: I have been taking Lipitor for about a month now. I also
take it with an 80mg asprin as well as a multi vitamin every
day. I currently have the flu and was wondering if I can
take cold medication (ie. Nyquil/Dayquil, Dristan) with it.

Answer: Shouldn't be a problem.

[posted 11/4/1999]
Question: I have been taking Lipitor (20mg) for about 3 weeks for high cholesterol (301). I have also eliminated probably 75% of the saturated fat and other sources of external cholesterol from my diet.
Several days after beginning Lipitor I began experiencing pain in my upper abdomen/lower chest, as well as in my upper right back. This pain occurs several hours after eating, and subsides after a meal. Usually it is a dull pain but at times it can be quite sharp. Is it possible that the Lipitor could be causing this, perhaps a side-effect related to liver function?

Answer: Possibly, get your liver functions checked. Also, possibly gall bladder dysfunction, unrelated to the Lipitor.

[posted 11/18/1999]
Question: Dear Doc,

I have had type-1 diabetes for 21 years. I'm 32.
I recently had a cholesterol check and it was 189
with an LDL of 132. My doctor wants me to begin
taking 10mg of Lipitor each day to reduce the LDL.
I had a liver test and it came out normal so he
wants to start me on this drug immediately.

I did some checking and found that anything below 130
is fine, and borderline is 130-160.

My 132 is barely over the border, should I really have
to start taking this drug for the rest of my life?
He says that 132 is high and not borderline since I
I'm a diabetic. Is the scale different for diabetics?

Could you give me a 2nd opinion or alternate options?

Regards,

Dave

Answer: The scale is different for diabetics. What to treat is debated, but most would shoot for LDLs of less than 110, many below 100. There are no controlled studies. But, we extrapolate studies done in post bypass patients that show that LDLs need to be below 100 to keep the grafts open. However, 5 mg would probably be sufficient, start here and see what your LDL is.

[posted 11/15/1999]
Question: Lipitor at 10mg or 20mg clearly slows my sexual drive down. What other cholesterol lowereing drug would you recommend which might not have this side effect?

Answer: Try Tricor or Lopid, different class of drug and don't seem to have this problem.

[posted 11/13/1999]
Question: My cholesterol was 231, hdl 54, ldl 156 in spite of dietary efforts and exercise, so my doctor started me on Lipitor 10 mg 7/99. Blood tests in 10/99 showed liver tests normal, cholesterol of 149, hdl 52, and ldl 82. Triglycerides came down from 105 to 73. I asked my doctor if I could take a smaller dose or take half a pill a day, considering the big drop in cholesterol. He said to try taking a pill every other day, and we would recheck the blood in 6 weeks. My wife, who is a cardiology R.N., has not heard of skipping a pill every other day and wonders if this is appropriate.She thinks I should be taking a half pill daily. My goal is to take as little Lipitor as necessary to keep my cholesterol in a safe range. Please advise.

Answer: One half every day would be most physicians answer. The drug only inhibits cholesterol metabolism when it is present. It does not inhibit cholesterol when it is not present in the blood. Due to its 1/2 life, best at once per day.

[posted 11/4/1999]
Question: We are planning a baby and would like to know when I should stop taking Lipitor?

Answer: A month before conception would be more than enough.

[posted 08/27/1999]
Question: Regarding Lipitor, which I have just started taking: Are the side effects of muscle soreness and elevated CPK readings related to one another or separate issues?
Is muscle soreness, by itself, a reason to quit taking Lipitor or will it gradually go away with continued use?

Answer: Related to the same problem and there should be an elevated CPK if there is muscle soreness from the medication. It will not go away and should dictate another class of cholesterol lowering drugs.

[posted 08/25/1999]
Question: I have read that Lipitor depletes the body of Coenzyme Q10. Is it ok to take a Coenzyme Q10 supplement while on Lipitor. I also take Lotrel for hypertension.

Answer: No problem.

[posted 10/30/1999]
Question: I have been suffering aching of the calf muscles and headaches at night and in the early morning. Are these a direct result of taking the drug lipitor, and what should I do about them? I have reported these symptoms to my specialist but he does not seem to be worried. As far as I know my liver enzymes have not been checked and my next blood test (lipogram) is only scheduled for February next year (2000).

Answer: You need to get a blood level of CPK, this is an enzyme produced by muscles when inflammed and elevated in about 1% of pateints on HMG Co A Reductase drugs. If up, this is a relative contraindication to taking the class of drugs. If normal, check a sedimentation rate to rule out inflammatory conditions(lupus and the like)-this would have nothing to do with the cholesterol drug but, would need to be treated separately. If you have been on the Lipitor for some time it is probably not the Lipitor(unless you have recently incresed dosage). If you have just started, very likely.

[posted 08/21/1999]
Question: I had the desease Hepatitus in 1980, any danger in taking the drug Lipitor? I know Hepatitus affects the liver and a possible side affect of Lipitor may affect the kindney,correct?

Answer: Probably not, but would depend a lot on what type of Hepatitis you had. A would be no problem about 10-20% of patients with Hepatitis B would have chronic liver inflammation and virtually all patients with Hepatitis C. You would have to be clear about your liver enzymes prior to taking the medication. Most patients have had A which would be no problem.

[posted 08/21/1999]
Question: IS IT OK TO TAKE ALLEGRA OR CLARITIN WHILE TAKING THE FOLLOWING DRUGS:
CARDIZEM CD 240MG/DAY, LIPITOR 10MG/DAY, DESYREL 100MG/DAY,
AMBIEN 2.5MG/DAY, ASPRIN 325MG/DAY.
ONE DOCTOR HAS TOLD ME I SHOULD NOT BECAUSE OF THE ADDITIONAL LOAD ON THE LIVER. HOWEVER, ANOTHER DOCTOR HAS TOLD ME IT WOULD BE OK. MY SEASONAL ALLERGIES ARE STARTING TO KICK IN SO I WOULD LIKE TO START TAKING CLARITIN OR ALLEGRA (MY PREFERENCE IS ALLEGRA).

Answer: Shouldn't be a problem but you should be getting periodic tests of liver functions on lipitor in any case-regardless of other drugs.

[posted 08/18/1999]
Question: I have been taking lipitor and other statin drugs for the last 18 months. Recently I had a blood workout done, and my liver enzimes were very high (ast 67, alt 95, and ggtp 150).
Is this a result from lipitor? Do the other statin drugs have this same side effect?

Answer: Maybe, I'd stop the drug for a month and recheck . Usually, they go back to normal at that point. If so, restart the drug and recheck them in 4-6 weeks. There are many things that cause liver enzyme problems and although the medication can, it isn't very common. Generally, you can restart the drug without problems. Other statins generally have the same problem as do all the cholesterol drugs exept the binding resins like Questran.

[posted 10/16/1999]
Question: I have had several surgical procedures in the past year. The first was Bladder surgery to remove a non-cancerous growth. In February I suffered a minor heart attack. They treated me with Angioplast and installation of a stent. In April I had a total right knee replacement. In May I had a prostrate reduction. The only drug I am on now is Toprol and one asperin a day. During the time of my operations I was on a variety of drugs but haven't taken any other than those indicated for over four months. Prior to my operations I was very active until the knee pain became such that I couldn't exercise. Therefore for the past year I have been rather inactive other than walking about 2-3 miles a day. In 12/98 my cholesterol was 195 and my hdl was 38 and my ldl was 114. At this time I was very inactive. I was not paying special attention to my diet and was very stressed due to the pain and job requirements. After my heart surgery my doctor wanted to put me on Lipitor. I indicated that I would rather try to exercise more and eat right to see how that would impact my Cholesterol levels. For the past four months I have been exercising religously. I have almost totally eliminated as much cholesterol, saturated fats and sweets as possible from my diet. My intake of these types of foods was extremely low. On 10/6/99 I had my cholesterol rechecked and my Cholesterol level was higher and my HDL level was lower. My levels for the 10/6/99 tests were 208 for Cholesterol, 34 for HDL and 134 for LDL. This surprised me because the results were worse than my 12/98 tests when I was very inactive, not watching my diet and heavily stressed.My questions are:
1. Is Toprol effecting my cholesterol levels.
2. Could any of the drugs that I took during my various surgeries have a long term effect that would be keeping my cholesterol at unsatisfactory levels even though I haven't taken them in over four months.
3. Could I have done anything different in the past four months to make my levels better.
4. I am not very big on taking drugs. Is it now time for me to start Lipitor knowing that it will be for the long run.
5. Lipitor is very expensive.I am a senior on fixed income. Is there a more reasonably priced alternative if I have to take something.
Thank you for your help.

Answer: Toprol is probably not related to your cholesterol levels. The cholesterol usually only improves if you lose weight. Cutting fat and exercise is nice, but is rarely effective without weight loss. Lipitor would be fine, you'll probably only need 5-10 mg to achieve your goal. Some doctors would advocate raising your HDL with drugs like Lopid,Tricor and the like. See what your HDL does on Lipitor, there are some patients who rise with this drug. In terms of price, buy the 20 mg and cut them in 1/2. Also, Baycol and Leschol are usually cheaper. With the levels of your cholesterol these would be ok. They can also be purchased in larges sizes and cut them in 1/2-usually very cost effective.

[posted 08/17/1999]
Question: I am a 52 I try to minimize my fat intake, I exercise
aerobically at least an average of 5 times/week but
have had high cholesterol for sometime and my trigs are
high. My most current blood work shows the following:
cholesterol - 364, Trigs - 298, HDL - 63, LDL - 241,
and Chol/HDL - 5.78 I have been able to reduce it
once or twice in the last 20 years but cannot keep it down.
My blood pressure is ok, but seems to be edging up over
the past year it has ranged from 72-90 and 116-160. I
cannot correalate the variations with anything in
particular.

My doctor has recommended lipitor to reduce my cholesterol
and lower my trigs, but I am little reluctant to take any
medication. We have agreed to retest my blood in 3-4
months. I am to pay very strict attention to the amount
of fat intake and reduce alcohol consumption.

My question is are there any natural herbal/vitamin
medications or supplements that I can take in place
of lipitor that will help reduce my cholesteral levels? I
realize that they may not work quite as effectively or
quickly, but my gut feel is that there should be some
knowledge in this area that is not necessarily widely
known. My physician did not seem to be knowledgeable in
this area of medicine and could not make any
recommendations. Also, if ultimately required to take
lipitor is this a life time affair or is it drug
that you can take for a while and then back off of it
when identified target levels are achieved, assuming
corresponding lifestyle changes are maintained?


Answer: High fiber intakes are about the only thing that works. The chinese are using supplements of red yeast, which appears to work in a similar manner to Lipitor and the like, so although "natural" I don't think it differs from your md's su ggestion.

[posted 08/15/1999]
Question: I have had high cholesterol for over 30 years that never
responded to exercise or diet. Since the advent of the new
cholesterol lowering drugs, I have tried them
all with not much luck until Lipitor came along. I am now
taking 20 mg daily for almost a year now with amazing
results. However, I have been suffering with some very
debilitating effects.The worst is the periodic explosive
diarhea, and a persistent pain in my left breast. I noticed
when I read the Q&A that two other women mentioned the same
thing. I have asked my doctor about this and he can offer
no reason.
My question for you is, could there be something being missed
here with women patients? Also, my liver tests showed an
extremely high reading in three succeding tests but returned
to normal in the last one without stopping the Lipitor.
My doctor has never suggested stopping the Lipitor to see
if that was the reason for my constant diarhea, but I am
going to stop it and see if it helps. I have had all of the
stool culture tests,abdominal sonagram, endoscophy, cat scan,
to determine the cause of the diarhea but everything is negative.
Have you ever seen this in patients taking Lipitor?

Answer: I have had two women with enlarged/sore breasts with this class of drugs. It doesn't seem to be drug specific. I'm not sure if it relates to changes in estrogen metabolism in the liver or direct effects of the drug. In both cases, we had to stop the drug. Diarrhea seems a little more common with lipitor than others of this class at least at the 20 mg dosage.

[posted 08/10/1999]
Question: my 57 yr old mother has high cholesterol and had quintuple bypass surgery in 9/97-I'm a 35 yr old male, 5'9" 158 lbs, exercise, dont smoke, and generally am healthy-my cholesterol last year was 240, and I reduced it some by diet, to about 210-my doctor then prescribed Lipitor at that point, 10mg/day--my mother's physician has questioned whether I should be on Lipitor with my cholesterol at these levels-since starting on Lipitor my levels have come down to between 150-170, but I'm wondering if I should be on the medication at all, given that my levels werent too far above 200 to begin with--my doctor obviously thinks I should be, and cites my family history and the fact that my levels are higher than he'd like to see them (he seems quite knowledgeable about the studies/stats regarding the drug)--is the risk of taking the drug at my cholesterol levels worth the reduction that has resulted?--I'm certainly pleased with my current cholesterol levels but am concerned about any long term effects of taking a potent drug (on my liver, mostly), probably for many years. thank you for your feedback.

Answer: No data here but studies in progress. If I had your family history, I would take the drugs. 5 mg might be a compromise, depending on the levels. Also, get your homocysteine and fibrinogen levels checked(other family risk factors).

[posted 08/5/1999]
Question: I have been on Zocor for nearly a year and my total Cholesterol has gone down from a high of 330 to 296. My LDL is 221. I was on 80mg of Zocor and now my MD
wants to put me on 40mg of Lipitor. My last blood test under heptatic panel showed "ALT SGPT" out of range at 53 (0-48 range).
What is Alt SGPT? I am also showing low testosterone. Is this a result of Zocor?

Answer: Zocor belongs to a class of drugs called HMG-CoA Reducatase Inhibitors. This class of drugs inhibits the enzyme in the liver responsible for endogenous production(cholesterol you make rather than absorb in your diet). Generally, it works a great deal better than the 10-15% you experiences. I would agree with the Lipitor, since it is a better inhibitor milligram for milligram. But, you may get similar results. Ensure, he/she has screened for hypothyroidism and diabetes mellitus-two potentially concurrent conditions which would limit effectiveness. Also, use of a concurrent binding resin may be very helpful. ALT SGPT are liver enzymes and are used to watch for potential liver toxicity-one of the few major side effects seen with this class of drug. Generally, we don't get very worried until the value is 2 or 3 times normal. 53 is elevated and bears watching but, if anything these tests are exceedingly sensitive and we watch for increasing trends and higher numbers. However, if it continues to rise would be a reason to limit the drug.

Lipitor and Higher Blood Pressure [posted 1/14/99]
Question: I was running high normal blood pressure (140/90) when I began taking Lipitor to reduce cholesterol. The cholesterol has gone down dramatically, but my blood pressure has gone up (165/105). Is there any possible connection between beginning Lipitor and the rise in blood pressure?

Answer: Shouldn't be.

Lipitor [posted 1/13/99]
Question: Please tell me about the drug Lipitor.

Answer: Lipitor is an HMG Co A Reductase Inhibitor. This class of drugs inhibits an enzyme in the liver, which is responsible for cholesterol metabolism in the body. Lipitor currently is the most potent per mg of the class. Side effects are usually pretty minimal, but serial testing of liver enzymes is necessary and occasional patients will have marked muscle inflammation, which necessitates stopping the drug. There is a long list of other minor problems.

Lipitor vs. Zocor [posted 1/13/99]
Question: What are the pros and cons on Lipitor vs. Zocor? Is one preferred over the other?

Answer: They're pretty similar. Lipitor is somewhat more potent mg for mg, but they have similar side effects and lowering of cholesterol. I use them interchangeably.

Lipitor and the sun [posted 1/12/99]
Question: Our pharmacy has printed the we should avoid exposure to the sun when taking lipitor. No where else is this mentioned. Would you reply to this?

Answer: Not usually a concern.

Lipitor and Kidney Stones [posted 1/12/99]
Question: I have been taking Lipitor for three months. I have had a history of kidney stones for years, but recently the stone formation has increased considerably. Could there be a connection between the Lipitor and the formation of kidney stones?

Answer: Wouldn't think so.

Lipitor [posted 1/8/99]
Question: I began taking Lipitor (10 mg/day) for about six months ago for high cholesterol (250). Prior to that I took Gemfibrozil for 2 years. Since starting the Lipitor I have developed very dry skin on my hands which crack and bleed constantly. Also a large patch of dead skin has broken out into a lump in the small of my back. I also take one aspirin and one over the counter multi-vitamin pill each day. I also have a mild case of psoriasis on an elbow. Could the Lipitor be causing the problem with my hands and back?

Answer: Wouldn't think so. Probably the psoriasis, but stopping the Lipitor for a month might answer the question and wouldn't be a big deal.

Lipitor and Muscles [posted 1/7/99]
Question: I have been on Zocor and more recently Lipitor for about 3 years. During that time I have been experiencing joint and muscle aches. Today my blood work indicated the CPK enzyme in the blood. My physician is taking me off the Lipitor and in 3 weeks, I will have my blood re-tested. Does either of these two medications cause arthritis-like pains in the joints, a feeling of "achy" muscles, and a lack of energy? I also take tenormin 50 mg, zoloft 25 mg, ativan 2 mg, and use the inhaler serevent, together with a full regiment of vitamins and minerals. I am a 60 year old male and have been on a low fat diet with exercise program of walking 40+ minutes 6 of 7 days a work.

Answer: All the HMG Co A Reductase drugs can affect muscle inflammation and cause an elevated CPK. This is an indication to stop this class of drugs. However, it does not cause joint pains.

Lipitor and Grapefruit juice[posted 1/6/99]
Question: I read not to take lipitor with grapefruit juice. Is it ok to take with orange Juice? What effect does taking it with grapefruit juice have?

Answer: Grapefruit has a chemical, which blocks certain drugs from being absorbed properly. I have not heard this about Lipitor.

Lipitor and Fertility [posted 1/5/99]
Question:  Is there any reason to think that Lipitor (a cholesterol-lowering drug) could affect sperm count? If so, are other cholesterol-lowering drugs to be preferred?

Answer: No evidence of this.

Possible Side Effect of Lipitor   [posted 12/10/98]
Question:  My husband started taking Lipitor yesterday. Last night he woke up during the night and went into a tantrum-throwing pillows, swearing. He has always been very laid back-I've never seen anything like this from him. Is this possible a side effect of the Lipitor?

Answer: Possibly, but, would be very unusual. Muscle inflammation and liver problems are the most common. But, different people have different reactions. I would check with his doctor.

Lipitor & Alcohol  [posted 12/10/98]
Question:  I am taking the medication lipitor. I want to know if drinking alcohol with this medication is dangerous. I know the medication effects the liver so that is way I am kind of concerned. Also the warning label on the medication states no alcohol while taking this medication. I have not seen anything in the studies of lipitor that indicate any problems with alcohol consumption.

Answer: Both can affect the liver, hence the warning. However, low alcohol intake is probably ok. Keep an eye on your liver, but probably no big deal if you keep it under 2-3 drinks a day.

Lipitor, Dantrium & Liver Function Concerns   [posted 12/08/98]
Question: Should Lipitor and Dantrium be taken together as they both seem to have effects on liver function. The physiotherapist is concerned that the dantrium will reduce the tone in the weak muscles I use as well as the ones with high tone and make physiotherapy difficult. I have chosen not to take the dantrium at the current time because the tone is coming down without medication -- slowly yes. I also take Folic Acid 5 Mg and B12 250 mcg for high homocysteine levels these are prescribed by the cardiologist.

Answer: I think if you monitored the liver function tests, it would be ok. This should be ongoing with the Lipitor in any case.

Concerns about Restarting Lipitor   [posted 12/08/98]
Question: If you are taking Lipitor and monitoring tests show inflammation/damage to the liver is occurring, as you mentioned you should stop taking the drug. My mothers doctor did just this. However if this is occurring why would you then restart taking the drug, wouldn't you just discontinue rather than risk further damage? In her case her cholesterol level dropped but not significantly (approx. drop 20-30). What's the benefit of restarting the drug when you know there is a problem? Are you then experimenting with the patient to find the drug level that least affects the liver but still gives the gain and if so what's considered a fair gain based on the risk( i.e. a gain of a  drop of 80 might be worth it but a drop of 20 isn't?, when your level is 280) .  Do you change the cholesterol level ceiling for using this drug when you encounter this?  Can the liver regenerate an infinite number of times or does it have its limits? After all you only have one so I'm wondering if its worth the russian roulette with it?

Answer: Most elevations of liver functions are not due to the medications but the several hundred other causes of liver inflammation, usually viral or fatty liver. If one experiences elevated liver functions immediately, it is probably the drug. But, if it comes after one is on the drug for awhile, it is probably not the drug. Considering how effective the drug is, it doesn't make sense to stop it-if it is not the culprit. The best option, followed by most physicians, is to stop the drug for a couple of months and see if the liver functions go back to normal. Then restart the drug and follow the liver functions closely. If they again rise, stop the drug. If they do not, continue the drug. Her doctor is doing what most of us would do.

Is Dry Mouth a Lipitor Side Effect   [posted 12/04/98]
Question: Could dry mouth be caused by taking 10 mil of lipitor daily. I also take 400 mil sectral.

Answer: Probably not, but, I do have some patients who experience GI symptoms on lipitor and not on other HMG-CoA Reductase drugs.

  Lipitor & Lactose  [posted 12/04/98]
Question: Our doctor has recommended that my husband take Lipitor instead of  Zocor and suggested looking up the information on the net. His questions have been answered, but mine have not. I have not been able to take any of the cholesterol lowering drugs because they all use lactose as a filler. Does Lipitor have lactose in it? The doctor has tried having me take Cholestid, but the severe side effects were not worth the possible benefits of somewhat lower cholesterol readings. Our doctor has left the decision of taking medication up to me; we are on a  low-fat diet, but that does not affect my cholesterol level nor does most of the other medications.

Answer: I am not aware of lactose being used, but, you might check with the company to get an answer-Parke-Davis 800-223-0432.

Lipitor & Tiredness   [posted 12/02/98]
Question: Can you tell me if fatique and/or being "tired" is a side effect of Lipitor? I've been taking it for about a month. I sleep well at night and get about 7 to 8 hours of sleep a night. Please advise.

Answer: Not usually, check your liver functions and CPK levels if elevated could be the Lipitor.

Lipitor Concerns   [posted 11/25/98]
Question: I was currently told to take Lipitor for cholesterol of 270. I have heard all of the talk of the side effects and liver problems it can cause. I know that while on Lipitor you should be monitored, but can this medication ever cause enough liver damage in the first six weeks that the damage would be irreversible? Thank you for your help.

Answer: Shouldn't if started in small doses.

Lipitor Side Effect Information   [posted 11/24/98]
Question: I am taking lipitor and recently noticed breast enlargement. In searching the literature I can find only limited information on this side effect. My question is how prevalent is this and what, if anything can be done to correct it?  Evidently the manufacturer does not list this in the "side effects" portion of the write up.

Answer: I've had two patients with this problem out of probably 200 women on this or equivalent drugs. I haven't found any way to correct it other than to stop the medication and I have never come up with an adequate explanation of why this should occur, nor does the company know.

Where to go for Lipitor Information   [posted 11/24/98]
Question: I would like to know who to contact, other than my doctor regarding the side effects of lipitor. Thank you

Answer:  The company has a good scientific department-Pfizer 800-438-1985.

Lipitor & Kidney Concerns  [posted 11/17/98]
Question: I have always had very high cholesterol - as it appears to be hereditary. It was as high as 302 and as low as 354. Four months ago it was 386. I used Lipitor for 4 weeks and my cholesterol was lowered to 219! I always have eaten low fat diets and try to exercise regularly. Obviously, the Lipitor worked. My question is: I have only one kidney (Whilmes tumor as a child).I am a 47 year old female. As great as Lipitor has been to lower my cholesterol, is it possible it could cause any kidney damage? How long does a person have to take Lipitor -or is it a lifetime medication? Thank you for any answers regarding this drug - it has worked miracles for me.

Answer: You'll need to take it as long as your cholesterol is high. Weight loss is about the only fix for this problem. Kidney problems don't seem very prominent currently either long or short term.

Lipitor & Miscarriages [posted 11/13/98]
Question: I am a 29 year old female. I was recently told by my doctor that my Cholesterol was 250, and she put me on lipitor 10 mg. A day. She never told me of the risk involved with this drug. Two weeks after I started Taking lipitor I found out I was pregnant. I soon miscarried. Could Lipitor have caused this and shouldn't I have been warned of the side effects.

Answer: Wouldn't expect it too, but, not specifically studied in humans.

Could Lipitor be Causing Joint Pain [posted 11/4/98]
Question: I have a Cholesterol count of 248 and my bad cholesterol level is 130, I'm 59 yr. old female and take 10mg. of Inderal along with .0625 of Premarin, 200mg Vit. E, and Vit. C daily. I have tried several other cholesterol lowering drugs, but have had muscle aching. I started taking Lipitor and after about 3 weeks, experienced joint pain and some muscle pain. After going off of it, I still have joint pain, in knees and hip area. Could the Lipitor be aggravating the joints.

Answer: Not usually the joints, muscle inflammation yes-but, you should see an increase in a lab test called CPK.

General Lipitor Side Effects [posted 11/04/98]
Question: What are the side effects of lipitor?

Answer: Usually very few. Some patients experience GI symptoms and there can be elevation of liver enzymes-these need to be checked by blood tests so that the medication can be stopped if they rise while taking the medication.

Lipitor & Muscles Soreness [posted 11/03/98]
Question: I understand that Lipitor usage sometimes causes muscle soreness, but how does a cholesterol lowering drug interact with muscles? I am feeling a general soreness of the chest and neck muscles.

Answer: Hard to know, but, there should be an elevation of a lab test called CPK if there really is a problem. Have this checked.

Should You Mix Lipitor & Creatine [posted 10/30/98]
Question: I am currently taking Lipitor 10mg a day. My Cholesterol Level is down from 230 to 103 and liver functions look good. I work out about 3 times a week and was wondering if any information is available about taking creatine and/or andro-6 while taking Lipitor. Will they raise my cholesterol level? What about effects on my liver?

Answer:The only way to know is to start them and check your levels closely. However, I'd recommend avoiding them. You should be working on lean muscles not bulk if you want to help your heart.

Can You Consume Alcohol with Lipitor [posted 10/30/98]
Question: Is alcohol consumption while taking this drug OK? At what levels of consumption.

Answer: Moderate levels are ok, understand that alcohol has an effect on cholesterol metabolism and there is clearly an interaction. Also, both drugs can cause liver toxicity, whether they are additive is unclear. However, one or two a day seems clinically ok, higher intakes should be avoided.

Can Lipitor Cause Muscle Tension & Lymph Nodes Problems [posted 10/30/98]
Question: The lymph nodes on my right neck and muscle tension and strain have been quite a problem in the past two months for me. I have been to an ENT specialist and my family doctor and took antibiotics for an infection for 24 days. I still have poofiness in my neck and occasional muscle strain. Could Lipitor which I have been on for about 5 months be causing this?. Everything else seems to be eliminated as a source to my discomfort.

Answer: Shouldn't be;but, stop it for 4 weeks and see what happens. I doubt that you will see a change.

Best Time to Take Lipitor [posted 10/28/98]
Question: Should Lipitor be taken at a specific time of time - with/without food? I have been on Zocor and Pravachol and gotten some small improvements. How long will it take to see if Lipitor has a better effect?

Answer: Lipitor works quickly, so a week or so will tell. Bedtime is the recommended time;but, it probably doesn't matter a lot.

High Gamma-Glutamyl Transpeptidase [posted 10/20/98]
Question: Question: My level of ggtp is 183mg/dl, I was taking Mevacor, 40mg daily total cholesterol 218, ggt 119 switched to Lipitor 10mg daily and after 3 weeks use total at 190. Is there anything that would elevate the ggtp other than alcohol, could any high use of vitamins elevate ggtp.

Answer: The statin drugs certainly can and you should probably have a 30-45 day holiday to see what the effect of a lipitor holiday would be on your liver functions. Also, the next most likely cause is so called "fatty liver" probably an early marker for diabetes.

Myopathy & Malaise, a Lipitor Side Effect? [posted 10/16/98]
Question: Is it common to have side effects with Lipitor/Sortis such as myopathia and malaise? I don't always have these symptoms on a daily basis but I do get them often enough to notice. I am taking 20mg daily along with a glass of Quantalan/Questran 9g at different times of the day so they don't bind.

Answer: About 1% of patients will develop myositis according to the literature. In my experience, it is much less depending on the dosage. Check your CPK and liver enzymes if normal, shouldn't be a problem. If high, you should avoid this medication.

Is Weight Gain a Lipitor Side Effect? [posted 10/13/98]
Question: I am a 27 year old female and am taking Lipitor. In January, my cholesterol was 354. I was not overweight and ate very well. Both of my parents have high cholesterol(my father takes Lipitor, as well). I started out on Lopid, but it only brought my cholesterol down to 280. I have been on Lipitor for 4 months and it is down to 242. However, I have gained 15 pounds and have not changed my eating habits. Is this a side effect?

Answer: Not usually.

Is Breast Pain Related to Lipitor ? [posted 10/8/98]
Question: I recently developed a problem w/ Pericarditis which has the same distinct painful condition in the left breast area discussed above. I pass this on to you because of the similarities to the question posed here on 7/30/98.

Answer: I doubt that the breast pain is the Lipitor. It is possible that you are experiencing GI symptoms that you feel in your left chest-really from your stomach. Secondly, some patients have GI symptoms on Lipitor who do not on Zocor, I'd switch and see if the symptoms persist, or give it a drug trial for 3 weeks and see if the problem persists. It should be gone in about one week if it is the Lipitor.

Lipitor [posted 10/8/98]
Question: I am currently taking the drug, Lipitor, to lower my cholesterol and was wondering if there was any side effects with the drug? One thing that I have noticed is that there is a sore spot on my rectum area. If I stop taking the drug for a week or so, the soreness goes away. It is like a bump that forms making it hard to sit or even use the restroom. Any other related side effects like this reported? This has happened to me twice now, so I am going to discontinue using the drug until further notice concerning this side effect.

Answer: Usual side effects are muscle inflammation(1%), liver inflammation (5%) usually dose dependent, and a host of other problems which are relatively individual. In general, a well tolerated drug. I have had some patients develop constipation. This may be the cause of your peri rectal problem. I'd try Zocor next if Lipitor can't be tolerated. For some reason, patients usually have different reactions even though it is in the same class of drugs.

Concerns about New Study with Lipitor [posted 10/8/98]
Question:I have recently started taking lipitor. A friend copied an article for me which says and I quote "An article published in the JAMA summarized the carcinogenicity studies of cholesterol-lowering drugs and clearly demonstrated that the risk of carcinogenicity for these drugs is far above recently issued FDA guidelines". The article specifically mentions the liver in connection with the carcinogenicity and describes the drugs as extremely carcinogenic. This particularly worries me as I have suffered from cancer. I feel that I need to know as much as possible about the carcinogenic risks from this drug due to my history. Please can you forward any information that you have.

Answer: I don't agree with this. There can be an effect on the liver, but, this is easily monitored. I would check with the scientific department of the company for the drug you are taking. Easily done by your doctor for more specific information. But, I wouldn't be concerned with this-at least at this time-things change with time/research.

When to take Lipitor [posted 10/6/98]
Question:My husband has been taking Lipitor for about 5 weeks. He has developed a red, itchy, rash on both upper arms that comes and goes. Is this a side effect of the medication.

Answer: Possibly, but, would be uncommon. Stop the drug for several weeks and see if the rash disappears. Then restart the Lipitor and see if it returns, this is probably the best test to see if it is responsible.

When to take Lipitor [posted 10/2/98]
Question: The cardiologist recently suggested I cut my Lipitor 20 MG pills in half and increase the amount to 30 MGs a day in order to lower my LDLs. My LDL were about 100. Should I take the 30 MGs all at once or should I take them at different times of the day? Is there a "best" time to take Lipitor to maximize its effects?

Answer: Nighttime is thought to be the best time since cholesterol metabolism rises during the night. Take them all at once.

Lipitor Side Effects [posted 10/2/98]
Question:I have had some side affects while taking lipitor for 8 weeks. During the first week I experienced vivid nightmares, they stopped after the second week. I'm now having a lot of dizziness. I'm taking 10mg. of lipitor. 150 mg. of Zoloft, 25 mg. of Atenolol and 40 mg. of Prilosec daily. I feel I'm on way to many drugs and am very concerned. The dizziness is almost daily. My doctor doesn't seem concerned. Any suggestions please.

Answer: Well, first is the Lipitor responsible for the dizziness? I'd suspect either the zoloft or the atenolol. Get established first which drug is the culprit.

Lipitor [posted 10/2/98]
Question:I have been having increasing muscle pain in my arms and legs, cloudiness in my head and tiredness. I feel it is being caused by the Lipitor. My question is how long after you stop taking the drug can you expect the side effects to go away. Is there a danger if you stop and start this drug? I also take prempro and wondered if the two drugs together could be causing my problems.

Answer: About a week usually, there is no problem in abruptly stopping the drug. Offhand, there should be no interactive problem;however, both are metabolized by the liver-a potential interaction there.

Lipitor [posted 10/2/98]
Question:I have been taking Lipitor for chlolesterol  for 6 months. I have had muscle aches in my calves from the onset. I originally attributed the pain to jogging, but due to an ankle injury, I stopped jogging about 2 months ago. The muscle aches in my calves got worse. I quit Lipitor for a week and the aches subsided. I resumed and the pain returned, even more severe. I now have reduced the dose by 50% and the aches are much reduced. Should I continue with the medication?

Answer: Lipitor and the whole class of HMG CoA Reductase cholesterol lowering agents can inflame muscle in about 1% of patients. You need to check your cpk levels with your doctor. If elevated stop this class of drugs for good.

Lipitor [posted 10/2/98]
Question:My doctor has me on a drug called Lipitor, to decrease my cholesterol, and he recommended that I take it at night, about two hours before retiring, and not to eat or drink anything after I take the drug until I get up the next morning. My question is how long should that be in hours, or do you have a suggestion. He indicated that giving my liver a break after taking the drug would make it work better. I take 10 milligrams a day.

Answer:The lack of food intake is not usually recommended. Also, you should be having regular liver function tests and stop the drug if they become elevated. It is not thought that you need to "give your liver a rest" if there is no elevation of the liver function tests.

Lipitor [posted 10/2/98]
Question: I have read an article that suggested that LIPITOR could be linked to depression.However no source was quoted. Have you heard anything similar?

Answer: No. I have had one or two patients who did experience difficulty concentrating and/or a feeling of being intoxicated.

Lipitor [posted 10/1/98]
Question: I take 10mg lipitor at bedtime. I awake with a stiff neck and sore shoulder muscles in the morning that diminishes as the day goes on. My blood work did not indicate anything unusual. On the few times that I forgot to take it, there was no soreness in the morning. Lipitor has lowered my ldl, but has not had an impact yet on hdl or triglicerides.

Answer: The class of HMG Co A reductase medications can produce muscle inflammation in about 1% of patients. This is a relative contraindication to using the medication. Checking of your CPK levels is usually done to confirm the diagnosis. However, if elevated, I would use a different medication class.

Lipitor [posted 8/14/98]
Question: Does lipitor have any negative effect on men's sexual drive?

Answer: Not a common problem, but it can cause breast enlargement. Hence, it’s clear that it can have some sexual effect in occasional patients.

Lipitor [posted 8/14/98]
Question: I am female, 46, who managed to lower triglycerides and cholesterol to 388 (tris) and 279 cholesterol with diet and herbs. The doctor put me on lipitor about 3 weeks ago and I am tired, cloudy-headed and have developed severe acid reflux. Also I have some elevated liver readings. Would pravachol be better for me?

Answer: They should act about the same in terms of side effects. However, pravachol is somewhat different structurally and may be worth a try. I suspect the liver functions will persist. The other symptoms are probably not the lipitor.

Lipitor and Liver Function [posted 8/11/98]
Question: I am taking lipitor to reduce my LDL cholesterol and increase my HDL. How often should my blood be tested to determine whether the drug is having an adverse impact on my liver function?

Answer: I’d do it at one month, then every 3-4 months for a year and then every 6 months (unless the dosage is increased).

Lipitor and the Liver [posted 8/11/98]
Question: My husband was put on Lipitor 6 months ago due to high cholesterol. He is 37 years old. He had a stroke when he was 32 and a blood clot in the entire right leg vein last year. His doctor put him on this drug treatment due to his past history and family history. His cholesterol was over 340. He was on 10 mg daily for 2 months and his cholesterol level didn't drop much. For the past 4 months he has been on 20 mg daily and he just had a check up and his cholesterol is finally down to 217. However, his blood work showed an increase in an enzyme being released by his liver. He has more blood work done in a week to double check this. What kind of an enzyme is it? What does this mean? Does alcohol consumption play a role in all of this?

Answer: One of the potential tonicities is liver. The test is enzymes produced by the liver which rise when inflammation/damage to the liver occurs. Many things can cause this and if it is only one enzyme, usually not a big deal. However, we usually stop the drug to see if they return to normal and then restart the drug with close monitoring of the liver tests. If numerous enzymes rise and especially if double normal values, more of a potential problem. By the way, there are other familial factors that should have been checked with the clotting. These would include homocysteine levels, Protein S and Protein C deficiency, Antithrombin III levels, Factor V Leyden levels, etc. Lastly would be Lupus anticoagulants. These must be checked in young patients with clots - they can be treated and will occur in sibling/children if not diagnosed. If your physician is not familiar with these see a good Internist or a Hematologist.

Side Effects of Lipitor [posted 8/11/98]
Question: I am concerned with any side effects that the drug Lipitor may cause. Could you inform me of any?

Question: Generally a very well tolerated drug. Occasional patients experience liver inflammation and liver enzymes should be checked a few times a year. Occasional patients will experience muscular inflammation. This is usually almost immediate with taking the drug and is experienced as stiff, sore muscles. CPK levels are elevated and the drug must be immediately discontinued. There is a long list of occasional problems - on the order of 1%, but very unpredictable. Most patients do not know they are taking the drug. Side effects are reversible when stopped.

Lipitor [posted 8/7/98]
Question: I have been taking 10 mg of Lipitor for about 4 months now. My cholesterol level has been recorded as high as 404 untreated. My doctor has prescribed all other cholesterol lowering drugs, Mevacor and Zocor have done the best (80 mg), but he decided that Lipitor would be worth a try as my level was still 246. My good cholesterol vs. the bad cholesterol is close to 136 vs. 110. Should I worry? He wants me to increase my Lipitor to 20 mg a day. I have been experiencing stomach pain, nausea and light-headedness (more recently) and flatulence also. I was wondering if the light-headedness could be related to Lipitor? My triglyicerides are very low prior to treatment, about 45. I also take estrogen daily and Zestril for high blood pressure (5 mg a day). What other enzymes does Lipitor effect while preventing the production of cholesterol by the liver? I was wondering how or what this does to my body?

Answer: It is supposed to affect only one enzyme and works in a very similar way to Zocor and Mevacor. Generally, there are few differences. However, I have a couple of patients who are ok on Zocor, but cannot take Lipitor - nausea primarily. I suspect the only way you will know is to stop it for 3-4 weeks and see if the symptoms abate, then restart the drug and see if they return. There is no specific advantage of Lipitor over Zocor except that it is somewhat more specific in inhibiting the liver enzyme responsible for cholesterol metabolism.

Lipitor [posted 8/7/98]
Question: What are the side effects of lipitor?

Answer: Lipitor is a newer cholesterol lowering agent. Like most drugs there is a large list of potential problems. However, in general there are very few problems with the class of HMG CoA Reductase Inhibitors and Lipitor in particular. This is because it inhibits one specific enzyme in the liver responsible for cholesterol metabolism. Regular blood checks should be done to look for elevated liver enzymes and the drug stopped if this occurs. Occasional patients have inflamed muscles the major symptom being pain, soreness, etc. This is also a contraindication to taking the drug. Occasional patients have isolated problems here and there, but in general it is a very safe, tolerated drug.

Lipitor and Niacin [posted 7/31/98]
Question: I had a follow-up blood cholesterol/triglyceride test done in January 1998 and the results were no improvement over results of testing done last September. My physician had prescribed my taking 81 mg aspirin daily, along with Niacin (100 mg), doing some dieting and getting more exercise. I am 44, weigh 180-185, and stand at 5"10". My last blood test showed my Triglycerides were at 461mg/dl and Cholesterol at 251 mg/dl. My father died from a heart attack at age 48 back in 1970, and his father had died from a heart attack at age 56 back in 1945. There is definitely a risk factor in the male blood line on my father's side. I decided to supplement my pill taking with a few more vitamins - Vitamin C with Rose Hips (1000 mg), Zinc (50 mg) and every third day, Vitamin E (400 IU USP). Now that I have been given a prescription for Lipitor (10 mg), my physician says that the Niacin supplement has to be stopped, and the drug interaction section of the pharmacists letter specifically mentions Niacin (nicotinic acid) as something my physician needs to know about. What are the contraindications for use of Lipitor with Niacin? Can I use a regular vitamin supplement which contains only 100% of daily recommended dosage versus the 500% I was taking? Should I discontinue taking any of these other vitamins - or avoid any other over-the counter medications while taking Lipitor?

Answer: Both work in the liver and there can be liver toxicity in taking both. It can be done, but needs to have close observation of liver functions and is rarely done by physicians unless the Lipitor is insufficient alone. With your cholesterol this will not be the case, stop any oral Niacin. The Vitamin C and Vitamin E are ok, same with the zinc. No problem with most over the counter medications, just niacin.

Lipitor & Breast Pain: Any Relation? [posted 7/30/98]
Question: My doctor prescribed Lipitor to reduce my cholesterol and I have been taking it for about 2.5 months. It has caused a pain in my upper left breast area ever since I started it. My doctor checked my liver enzymes and they were fine. However, the pain has progressed to the point I can no longer take the drug. I also have a lot of gastric and digestive symptoms. I was curious if others had experienced these symptoms on lipitor?

Answer: Very unusual - if it is affecting your breasts why not both? Stop it for a trial. Off hand I don't have any great ideas.

Lipitor's Effect on Sexual Desire [posted 7/30/98]
Question: Does this drug have any effect on sexual desires?

Answer: Usually has no effect.

Lipitor Side Effects [posted 7/30/98]
Question: Can a possible side effect of Lipitor be muscle pain and joint pain?

Answer: Muscle pain yes, Joint pain rarely.

Reactions to Lipitor [posted 7/27/98]
Question: I just started taking lipitor. I take it during the daytime and it makes me real nervous. I also have to also urinate every 30 minutes or so. Are these common reactions to Lipitor? Also, does taking lipitor cause long term damage to the kidneys, liver, etc.?

Answer: Very uncommon, especially the urinary frequency. Does it stop if you stop the medication? Long term there should be no damage if occasional tests are done. This class of drugs necessitates occasional liver function tests. Yearly, renal function would be appropriate.

Rash, Lipitor and Lamisil [posted 7/24/98]
Question: I have been taking both Lipitor and Lamisil for 3 and one half weeks. I developed a rash that forms scratch marks and red streaks and then an itchy rash that disappears in about 30 minutes only to reappear later. I discontinued the Lamisil after the doctor visit a week ago, but I still have the condition. Could I be having a reaction to the Lipitor?

Answer: Hard to know, both of these drugs potentially affect the liver. Have you had liver function tests? I'd stop both, and restart the lipitor after the problem is completely gone a month or so. If it goes then assume it is the lamisil or the interaction of the two.

Lipitor and hair loss
Question: I was taking provacal and it caused my hair to thin out. Is there any such side effect with lipitor?

Answer: I don't know why you should have this symptom with pravachol, but lipitor is similar although a structurally different drug. I guess I'd stop the drug and see if the thinning stops prior to starting a new drug. Are you taking any other drugs? Beta blockers are notorious for thinning of hair.

High Triglycerides
Question: My cardiologist suggested Lipitor because my triglycerides are high(442) and my HDL is low(27). I have been on Mevacor which has been controlling my total cholesterol(166) and LDL. I have read about Niacin, which might help this situation, and have been taking 500mg daily. My cardiologist said that the Lipitor hasn’t been approved in this country, so I was concerned. Should I try the Niacin or consider the Lipitor?

Answer: Lipitor is the first HMG-Co A Inhibitor to have an effect on triglycerides. This is due to the high affinity for lipitor to the enzyme that it is inhibiting. Lipitor will be released at the end of this month. I'd try it first. Also, triglycerides have a minimal effect (if any) on increasing cardiac risk. I think they are useful to decrease, but they are a minor player compared to cholesterol. Lipitor has the potential to be the best of the HMG-Co A drugs.

Lipitor
Question: Do you have any data on Lipitor (Atorvastatin)?

Answer: Lipitor(Atorvastatin) is the newest HMG Co-A drug. This is a class of drugs that works on the enzyme in the liver responsible for " turning on" cholesterol production. About 80% or so of cholesterol is produced by your liver. Reducing the liver’s production will decrease cholesterol. Lipitor seems to be more effective and efficient than its predecessors. It also is the first HMG Co-A which is approved by the FDA to reduce triglyceride levels, a major improvement. Side effects seem to be the same as for the other drugs in this class. However, like most drugs, time may change out opinion. The drug has only been out 2 to 3 months here in the U.S. and the U.S. is much more critical and observant of drug performance than other countries where it has already been tried. My personal opinion is that it is a major advance compared to other drugs of its class. The company has also been smart and priced it to be competitive with Zocor, the previous best HMG Co-A.



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