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Lipitor causing neuropathy issues in CVD patient with stents

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hi I am after some help on what medication I should take. My current cholesterol levels without any med's are 1.09 HDL, 1.7 LDL & 2.8 Tri = 5.6 total cholesterol. I am in the high risk catergory as I had a stent fitted last year (April 12') in my LAD. Rest of the arteries were good so I think i have a good chance to keep my cardiovascular system in good order with the right approach from here on in. I am a non smoker. No diabetes issues. Since the stent I have reduced my weight from 106kg to 86kg's and radically changed by diet (now eating all the right foods, wasn't before unfortunately way to much junk food and lack of veges and fruit). My total cholesterol at the time of my stent issue was 6.4 (obviously way to high).

With 40mg of Lipitor (after the stent was fitted) my cholesterol plummeted to 2.2 total cholesterol (which I consider is way to low and sent my body into meltdown). With 20mg of Lipitor I can maintain a comfortable 3.5 total cholsterol.
With 145mg of Lipidil I can maintain a comfortable 4.5 total cholsterol

My problem is that the Lipitor caused me to have some neuropathy issues (confirmed by neruologist) and I stopped taking that drug after 5 months. I am still battling these issues to this day but feel like I am getting on top of them finally. My nero told me that it's to early to be going back onto statins at this stage and I am going to follow her advice, although my cardiologist thinks otherwise (but I'd expect that would be his approach as he's only concerned about my cholesterol levels).

I have just started some nicitinic acid (250mg x 3 times per day) as I figured this is a natural supplement but don't know much else about it. I also have some Questran Lite as an option also if the nicitinic acid doesn't work for me.

I am after your advice and direction please, given my above circumstances and situation where I really need to get my cholestrol level down, I want to go onto a lipid lowering drug (to compliment my diet and exercise plan) but I don't know enough about how all the above drugs work (such as the statins work on the HMG-CoA, what process does Lipidil use to lower cholesterol and could it also have the same effect on my nerves as the lipitor did????) and given that the statins had some a dramatic effect on my nerves I cannot afford to take something again that will inflame the whole situation again for me.

What would you recommend my best course of action be?

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 22 Doctors Online

Hello,

Thank you for asking your query at DoctorSpring.

I congratulate you on your successful lifestyle changes resulting in weight loss and low cholesterol levels. Let me list down my opinion here for clarity.

1. You should focus on lowering LDL levels as a guideline rather than Total cholesterol. A value less than <100 mg/dL (2.58 mmol/L) is recommended.

2. Since you are almost near the target LDL , do continue lifestyle modifications

3. Nicotinic acid is a good alternative. But you might require even higher doses to have effect on LDL. But higher doses are more associated with side effects including peripheral neuropathy. Nicotinic acid improves the HDL (good cholesterol)

4. If you have started Nicotinic Acid, please continue it. See whether it improves the lipid profile without any major side effects.

5. If not I recommend Ezetimibe 5 to 10mg as the next alternative. It has a good safety profile and reasonably good effect on LDL and TC. Please consider this option in consult with your Doctor.

6. Reintroducing statin in a lower dose is also an option (as the side effect is probably dose depended) . But I would not recommend this option now.

Hope this helps

Please feel free to ask followup questions.

Regards


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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