Statin Alternative for High Cholesterol

[Bucky]

My levels are a bit high and I've been prescribed 2 different statins but both of them cause a lethargic, foggy, sluggish energy level to the point where I can't tolerate them even at a low dose.

Are there alternatives that have worked for any of you?  Or should I keep trying different iterations of statins?  

I'm already quite diligent on the lifestyle aspects for correction - diet, exercise, etc.  It's a hereditary thing.  😒

Edited January 2, 2023 by Bucky

[misterhumphries]

Please consult with your doctor. Anecdotal info only goes so far. Every person reacts differently to meds. You want to be prescribed a medication that your physician approves for your condition.

[Rudynate]

I see a preventive cardiologist who is also a researcher at UCSF.  He's one of those guys who finds the benefit from statins so clear-cut that he thinks nearly everybody should be taking one.  I have been taking a statin for nearly ten years.   He initially started me on atorvastatin, which gave me serious muscle pain, so he switched me to rosuvastatin at a dose of 20mg.  No problems whatsoever with sides. I'm thinking of asking him to increase it to 30 mg to get my LDL to below 70.  You might try one of the older statins that are less potent than atorvastatin or rosuvastatin.   There is also a natural alternative to statins called red yeast rice extract.  Most brands don't work, but there is one brand that actually works - Nature's Plus Herbal Actives Red Yeast Rice.

 

Check with your doc, of course.

Edited January 2, 2023 by Rudynate
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[Bucky]

thanks, @Rudynate

[Guest]

You didn't mention which statins you tried, but foggy thoughts and lethargy would be very rare side-effects. Now muscle pain and weakness would be common, but mental health symptoms pretty rare. There are plenty of meds other than statins to lower LDL, but none with similar efficacy, safety, and, usually, tolerability. If you're having unusual side-effects, I would suggest a lower dose of a high-potency statin rather than a higher dose of a low-potency statin. As RN intimated, rosuvastatin is the highest potency statin. I've never had a patient get side-effects on 5 mg of rosuvastatin (half of the lowest 10 mg dose), but that dose will cause a good drop in LDL-C. You'll have to contact your physician if you really can't take a statin. Some cholesterol meds aren't even absorbed (they bind to cholesterol in the intestines), but be prepared for gastrointestinal symptoms such as constipation, cramping, and bloating. 

[CJK]

The following is not being given as medical advice, but as a talking point for you and your doctor....

My heart issues are hereditary, too. My grandfather died in his late fifties. My father had his first heart attack at age 28, bypass at 47, his first heart transplant at 50, his second heart transplant at 57 and died at 58, my present age. (A previously undiagnosed infection may have exacerbated the heart condition.) My cholesterol was not very high, but after a heart attack it was decided lower would be better, I was not eating bad stuff, so diet alone was not going to work.

After fiddling around with various drugs, I went on a combination of atorvastatin (Lipitor) and ezetimibe (Zetia). It has been about a year, and it seems to be working without side effects. 

Edited January 3, 2023 by CJK

[dbar123]

Originally I started out on sim a statin and had lots of muscle soreness. My pcp switched me to pravastatin and I’ve had no problems with it

[Guest]

Taking Coenzyme Q with a statin has been suggested by some studies to lower muscle-related side-effects, but I don't imagine it would work with lethargy, etc.

[+ sniper]

I take Zetia.

[+ Pensant]

Not a doctor, but I think statins are way over-prescribed.

[Guest]

16 minutes ago, Pensant said:

Not a doctor, but I think statins are way over-prescribed.

While it's certainly the case that they're not miracle drugs, they are extremely safe, effective, and inexpensive (essentially all generic). What, specifically, is the basis for your statement, since you put it out there?

[+ Pensant]

6 minutes ago, Unicorn said:

While it's certainly the case that they're not miracle drugs, they are extremely safe, effective, and inexpensive (essentially all generic). What, specifically, is the basis for your statement, since you put it out there?

Agent provocateur?

[CJK]

On 1/2/2023 at 10:03 PM, CJK said:

...After fiddling around with various drugs, I went on a combination of atorvastatin (Lipitor) and ezetimibe (Zetia). It has been about a year, and it seems to be working without side effects. 

Until they stopped working. It has something to do with my creatine levels and kidney function. I had a catheterization on Friday. Blockage found. Surgery to unblock on Monday. So the statins were not blocking anything...

[NCHasNeeds]

Not meant to be taken as medical advice - take any of this and consult with your doctor and/or pharmacist. I am not a physician. Also, this is all written from a US perspective, so if you’re in another country YMMV.  
 

If the time to feeling bad is pretty quick (and is “on/off” as easy as stopping to take it, I’d consider trying other statins at low dosages to see if one works for you. It’s the best bang for your buck. There’s some evidence out there on “alternative dosing” regimens (e.g., every other day) that people believe to be better than no statin at all. 
 

If money isn’t an issue (or your provider can get a prior authorization approved for statin intolerance), PCSK9 inhibitors are another class of drugs that can lower LDL. They’re monthly or every 2 week (self) injections - Praluent and Repatha are the brand names. 

[+ robear]

After ~20 years of statin therapy (Lipitor/atorvastatin 10mg), at age 67 I am so weak and tight in my lower body that I can only walk or stand with effort and considerable discomfort. I've always thought there was a cumulative effect over time, which I've never seen studied. I didn't have the acute pain and weakness reported by others, and have tested negative for rhabdomyolysis several times. Nevertheless I first noticed a slight difficulty walking soon after starting therapy, and it has only gotten much worse over the years.

There's more going on, of course. Age, weight, inactivity, joint issues all take a toll, so I don't imagine dropping the statin will suddenly result in new-found youth. And there's clearly an upside. I have exactly my father's anatomy. He had is first heart attack at 60 and another 2 years later. To date I have no sign of heart disease.

I see the cardiologist in a few weeks and will ask her about halving my dose to 5mg/day, something I haven't tried before. I'm also taking icosapent ethyl 2gm (Vascepa) which helps balance lipids overall and has been effective with lowering my triglycerides and raising my HDL. I'll ask about increasing that to 4gm/day, which is more the standard dosing, and with these adjustments just let it go for 6 months and see what happens.

TLDR as the kids say: 67yo, long term statin user with marked physical decline. Statins work and are important to anyone with heart-disease risk factors. There may be a physical price to pay for their use, however, that needs to be evaluated in the big picture.

[Rod Hagen]

I would suggest you just keep plugging away at different Statins.  There are so many of them, you are bound to find one that works for you (I hope).  GOOD LUCK!!!

 

[Guest]

8 hours ago, robear said:

...Statins work and are important to anyone with heart-disease risk factors. There may be a physical price to pay for their use...

Where did you get this information about a "physical price to pay" for their use? If you truly have solid information, you should provide references. Otherwise, I would encourage you to avoid giving medical advice on issues with which you don't have information. Someone might actually believe your false statements, and consequently might inappropriately stop this potentially life-extending medication.  There is one, and only one, approved dose for Vascepa, and that's 4 g a day (two grams twice a day). That's what the research has shown is the safe and effective dose. If you want to substantially improve your health, I suggest consultations with a dietician and a course of physical therapy to help you improve mobility and physical activity. 

Edited January 30, 2023 by Unicorn

[+ glennnnn]

I am 79 and allergic to statins. I break out in itchy hives over most of my body if I consume any. My gerontologist has had me on zetia for years which seems to keep my cholesterol under control with no side effects. I also walk about 10 miles a week and maintain a decent diet. I wouldn't dream of making any changes without consulting the doctor.

[+ robear]

@Unicorn, if you had actually READ my post before climbing up on your customary sanctimonious high horse, it's obvious I was sharing a very personal perspective and experience as a long-term patient, nothing else. That millions of patients have reported physical effects of statin usage, to the extent many can't or won't take the drug, seems to have eluded you, but you can look that up yourself. My comments clearly came down on the side of benefits outweighing the costs.

And as for my use and dosing of Vascepa, I am certain, absolutely positive, that my prominent cardiologist in NYC knows a helluva lot more about it and me than you do so, as the saying goes, "I would encourage you to avoid giving medical advice on issues with which you don't have information."

[Rudynate]

I think the risk from statin use is way overblown and I am even someone who experienced ill effects from statins.  It wasn't statins that created the problem but that I was on the wrong statin for me.  Switched to a new statin and problem solved.  It all has the same feel to me as the anti-vax hysteria, except that it should have gone away by now.

 

My brother-in-law became convinced that his statin was affecting his mental status and stopped taking it for that reason.  He doesn't seem any better or worse off since he stopped. 

Edited January 31, 2023 by Rudynate
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[Guest]

On 1/30/2023 at 4:53 PM, robear said:

... I am certain, absolutely positive, that my prominent cardiologist in NYC knows a helluva lot more about it and me than you do ...

Well, then you're certain, absolutely positive, that he knows more about it than the committees at the FDA (the approvals have to go through two rounds of committees) who reviewed all the data on the medication. Yeah, right. 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/202057s035lbl.pdf

https://www.nejm.org/doi/full/10.1056/nejmoa1812792

I don't think anything's eluding me. But someone or something's deluding you.

(By the way, do you any actual facts to support your unequivocally certain, absolutely positive beliefs?)

And if it's your "prominent cardiologist in NYC" who told you your weakness was caused by statins, God help you. I'm not sure why he felt it necessary to check you for the same condition "several times" before thinking maybe something else was responsible. Or was he too high on his horse to request a consultation for a cause of the weakness? It's never a good sign when there's only one possibility considered over and over again when trying to come up with a differential diagnosis. 

Edited February 1, 2023 by Unicorn

[Rudynate]

On 1/30/2023 at 4:53 PM, robear said:

@Unicorn, if you had actually READ my post before climbing up on your customary sanctimonious high horse, it's obvious I was sharing a very personal perspective and experience as a long-term patient, nothing else. That millions of patients have reported physical effects of statin usage, to the extent many can't or won't take the drug, seems to have eluded you, but you can look that up yourself. My comments clearly came down on the side of benefits outweighing the costs.

And as for my use and dosing of Vascepa, I am certain, absolutely positive, that my prominent cardiologist in NYC knows a helluva lot more about it and me than you do so, as the saying goes, "I would encourage you to avoid giving medical advice on issues with which you don't have information."

My prominent San Francisco cardiologist would put them in the drinking water.  During my first appointment with him ten or so years ago he said, "All roads lead to statins."

[Beancounter]

I recently started taking a statin (Lipitor) and was instructed by the pharmacist to take it at bedtime because cholesterol tends to build up in the body during overnight hours.  Is this really the case?

[Guest]

6 hours ago, Beancounter said:

I recently started taking a statin (Lipitor) and was instructed by the pharmacist to take it at bedtime because cholesterol tends to build up in the body during overnight hours.  Is this really the case?

Pretty close. Most of the cholesterol in our blood is made by our livers, and this synthesis mostly occurs at night. The statins block the key enzyme needed to synthesize cholesterol (it's not really "building up"). So any statin is going to work better at bedtime. That being said, this was especially true of the older statins, lovastatin and simvastatin, which have really short half-lives. Lipitor (atorvastatin) hangs around for the better part of 24 hours, so it's not as important to take it at bedtime.

Edited February 2, 2023 by Unicorn

[+ tassojunior]

Wasn't there some discussion that statins may be pulled back some for older patients for some stroke risk ?  I'm on Atorvastatin 40mg and with permission of my doctor stopped for two weeks while I had covid and was taking the mini-shots of blood thinner because of a clot history. I would say after a couple weeks off I felt better and more alert, but then anyone 73 coming out of covid feels better. I started it back yesterday.