Dear Dr. Roach: I鈥檓 a 76-year-old male with a heart condition. I had a double bypass 11 years ago and a stent put in two years ago. Apparently, I鈥檓 allergic to statins. My side-effects have included muscle pain, memory glitches, fuzzy thinking, severe joint pain, fatigue, etc. The last statin I took (Crestor) was the worst, with muscle aches and fatigue persisting, even after quitting it three months ago. 聽
My doctor wants me to get back on a statin, but I question the wisdom of this recommendation. Also, at my age, medication side-effects seem to be magnified.
Any recommendations you may have would be appreciated. For your information, I exercise daily and am very careful with my diet 鈥� i.e., I eat few carbs, little to no red meat, etc.
B.E.
For people with known blockages in their arteries, statin-type drugs consistently have been shown to reduce risk of future heart attacks, strokes and overall risk of death. For this reason, I understand your doctor鈥檚 desire that you give a statin another try. While I certainly would wait until all the side-effects of the Crestor are gone, for a person in your situation I would try either pravastatin or fluvastatin, as these are the least likely to cause side-effects. In some people, coenzyme Q10 has been successful in preventing the muscle cramps that are a common side-effect of, but not a true allergy to, statin drugs.
Unfortunately, some people just cannot tolerate statins. In that case, in addition to the daily exercise and diet that you are doing, I would consider prescribing ezetimibe or one of the new injectable medicines. None of these has the efficacy or safety records that statins do; however, there is some evidence showing that not only do they reduce cholesterol, but they reduce risk of heart attacks in the future.
Dear Dr. Roach: In a recent column, you mentioned that a bleeding episode while on the new blood thinners was 鈥渋rreversible.鈥� Does this mean that in spite of transfusions, administering clotting agents and withholding the medicine, a patient would bleed to death? How can a doctor prescribe these with a clear conscience, and how can they even be on the market?
My husband takes Pradaxa.
K.M.
Indeed, there have been cases of uncontrolled bleeding while on Pradaxa and the other similar medications. As of November 2011, there were 260 fatal bleeding cases reported worldwide. Many of these were bleeds into the brain, which cannot be treated with clotting factors or transfusions. However, it鈥檚 important to recognize that the conditions for which these medicines are used, such as atrial fibrillation, cause stroke and death if not treated. That risk of stroke and death is reduced with treatment, whether it鈥檚 by Pradaxa or a newer medicine, or by the older warfarin (Coumadin). Also, the risk for bleeding into the brain is less with Pradaxa than it is with Coumadin (Coumadin, however, can be reversed with vitamin K or, in an emergency, with plasma or clotting factors). Since treatment is better than no treatment, these drugs are on the market, despite the fact that they will cause some people serious harm.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
