Intolerant to statins looking for alternative drugs and doctor recommendations

[CanNot]

Hello,

I have high cholesterol and LDL Cholesterol levels. Health wise I have a chronic neurologic condition.

Doctor said such high levels are genetically caused and could only be marginally reduced through exercise and weight loss. However I starting to exercise and lost 5kg so far.

I got Vytorin (10/20) (Ezetimibe/Simvastatin) prescript. Which caused extensive nerve pain. We tried a stand alone statin Atorvastatin which caused the same side effects.

I'm now in Ezetimibe + exercise and weight lost but my levels are still to high.

 

Doctor said last options are PCSK9 Inhibitors but I hesitate as its a injection and I cant just stop it like tablets if I got side effects from it.

 

I search for some alternatives and found new drugs like Bempedoic Acid (Nexletol) which I brought up at my latest consultation but to my surprise the Dr. never heard about it.

 

Is there a doctor in Bangkok who is who is up to date on the latest medication to treat elevated cholesterol levels?

[gargamon]

What dosage of lipitor (atorvastatin) did he/she have you on? Side effects are typically dosage dependant. 10mg/day is the usual starting point. Not sure if there's a smaller dose than that. I guess you could cut a 10 in half to experiment. 

[Ralf001]

lose more weight.

[lopburi3]

26 minutes ago, CanNot said:

 

Is there a doctor in Bangkok who is who is up to date on the latest medication to treat elevated cholesterol levels?

Be aware that medications used elsewhere may not be authorized here - and vis versa.  A quick google only shows a local distribution/maker for Asia in 2021 but no information on availability or approval in Thailand. 

[PFMills]

I found Rosuvastatin gave me the least side effects ...I take it with  Ezetimibe.

[Sheryl]

Bempedoic Acid (Nexletol)  is both very new and not available in Thailand. Which is likely why your doctor had not heard of it.

 

You mention only your LDL, are triglycerides OK?

 

Simvastatin and atorvastatin are both lipidophilic statins and that class of statins are more apt to cause or aggravate nerve pain. It might be worth trying a hydrophilic statin such as rosuvastatin as they are less likely to cause this effect.  

 

the other type of drug that might be considered is sustained release nicotinic acid. It used to be available as brand name Niaspan in Thailand but is now off market, but various brands can be purchased form iHerb as "nutritional supplements" (make sure it is the sustained release form)  https://th.iherb.com/search?kw=nicotinic acid sustained release. However discuss with your neurologist first whether this would be safe in terms of your neuro condition.

 

In terms of doctors, I suggest:

 

https://www.bumrungrad.com/en/doctors/rachanon-murathanun

 

 

 

 

 

 

 

 

 

 

 

[JackGats]

Red yeast rice is effective. Contains a statin though.

[CanNot]

1 hour ago, gargamon said:

What dosage of lipitor (atorvastatin) did he/she have you on? Side effects are typically dosage dependant. 10mg/day is the usual starting point. Not sure if there's a smaller dose than that. I guess you could cut a 10 in half to experiment. 

Yes, was on 10mg. Was thinking at the time to cut it, but stopped it completely. 

[CanNot]

49 minutes ago, Sheryl said:

triglycerides OK

Yes, that are the results after taking ezetimibe for some month. 

[SAFETY FIRST]

On 3/17/2024 at 5:46 AM, CanNot said:

tried a stand alone statin Atorvastatin which caused the same side effect

You may not need statin's 

 

Have you done a coronary calcium score?

 

I'm not expert, I'm fit and healthy but I've been listening to a few podcasts (healthy living) that discuss statins regularly. 

 

This doctor is the GOAT, he's switched on, so much knowledge. 

 

Statin's are needlessly over prescribed. 

 

 

 

[KhunLA]

Eat more healthy cholesterol, so your liver doesn't make the crap stuff.  May want to ignore some of the healthy eating advice they push.  Low fat, lean meat, as what you don't eat, you liver will make, and sucks at it, putting out LDL.   Eggs are a great source, and I eat a couple everyday, scrambled and cooked in olive oil & butter.

 

Keep on with the exercising and add intermittent fasting, which will help greatly with weight loss, and control.   Only thing that has worked for me.

[Sheryl]

2 hours ago, CanNot said:

Yes, that are the results after taking ezetimibe for some month. 

Make sure that LDL is a direct measure and not an indirect calculation as with your lower than average triglycerides indirect LDL calculation might not be accurate

[Sheryl]

3 hours ago, JackGats said:

Red yeast rice is effective. Contains a statin though.

Also a statin and in non-consistent doses so no advantage over taking a statin .

[KhunLA]

13 hours ago, CanNot said:

Yes, that are the results after taking ezetimibe for some month. 

That's after taking the statin ... 

 

Here's mine after taking Rosuvastatin (10mg), which I'm weening myself off of now.  Even though didn't start till 68 yrs old, really don't want to be an any med for long term.  

 

Before statin ... so they do work:

[mstevens]

14 hours ago, KhunLA said:

Eat more healthy cholesterol, so your liver doesn't make the crap stuff.  May want to ignore some of the healthy eating advice they push.  Low fat, lean meat, as what you don't eat, you liver will make, and sucks at it, putting out LDL.   Eggs are a great source, and I eat a couple everyday, scrambled and cooked in olive oil & butter.

 

Keep on with the exercising and add intermittent fasting, which will help greatly with weight loss, and control.   Only thing that has worked for me.

 

I've got to second this, it's really excellent advice.

Also, to the OP, your LDL is not that high. (My LDL is higher than yours and I am totally comfortable with it although my HDL is much higher and my triglycerides much lower than yours.) I'd actually look at upping your healthy fats (eggs, olive oil, avocados, red meat with the fat, chicken with the skin) and doing some resistance exercise, all of which will increase your HDL which is at the low end of normal.

[nickmondo]

On 3/17/2024 at 4:46 PM, CanNot said:

Hello,

I have high cholesterol and LDL Cholesterol levels. Health wise I have a chronic neurologic condition.

Doctor said such high levels are genetically caused and could only be marginally reduced through exercise and weight loss. However I starting to exercise and lost 5kg so far.

I got Vytorin (10/20) (Ezetimibe/Simvastatin) prescript. Which caused extensive nerve pain. We tried a stand alone statin Atorvastatin which caused the same side effects.

I'm now in Ezetimibe + exercise and weight lost but my levels are still to high.

 

Doctor said last options are PCSK9 Inhibitors but I hesitate as its a injection and I cant just stop it like tablets if I got side effects from it.

 

I search for some alternatives and found new drugs like Bempedoic Acid (Nexletol) which I brought up at my latest consultation but to my surprise the Dr. never heard about it.

 

Is there a doctor in Bangkok who is who is up to date on the latest medication to treat elevated cholesterol levels?

i would not take a statin even if my LDL was (according to my doctor) high.

I cannot advise you what to do, but if i were you I would be doing extensive research on the benefits of statins.  Dont be confused with relative and actual benefits.

[nickmondo]

On 3/18/2024 at 8:49 AM, KhunLA said:

That's after taking the statin ... 

 

Here's mine after taking Rosuvastatin (10mg), which I'm weening myself off of now.  Even though didn't start till 68 yrs old, really don't want to be an any med for long term.  

 

Before statin ... so they do work:

looking at your numbers, i would NEVER have taken statins.  Your numbers are not high.  Check out research on this.  Statins cause more harm than good

 

[newbee2022]

On 3/17/2024 at 4:46 PM, CanNot said:

Hello,

I have high cholesterol and LDL Cholesterol levels. Health wise I have a chronic neurologic condition.

Doctor said such high levels are genetically caused and could only be marginally reduced through exercise and weight loss. However I starting to exercise and lost 5kg so far.

I got Vytorin (10/20) (Ezetimibe/Simvastatin) prescript. Which caused extensive nerve pain. We tried a stand alone statin Atorvastatin which caused the same side effects.

I'm now in Ezetimibe + exercise and weight lost but my levels are still to high.

 

Doctor said last options are PCSK9 Inhibitors but I hesitate as its a injection and I cant just stop it like tablets if I got side effects from it.

 

I search for some alternatives and found new drugs like Bempedoic Acid (Nexletol) which I brought up at my latest consultation but to my surprise the Dr. never heard about it.

 

Is there a doctor in Bangkok who is who is up to date on the latest medication to treat elevated cholesterol levels?

Bempedoic acid might be an option. Try it. Side effects sometimes allergic reaction. I suppose you'll find a doc in Bangkok Int. Hospital. Docs trained abroad should know about these tablets.

[Carlotta]

On 3/17/2024 at 6:18 PM, Sheryl said:

the other type of drug that might be considered is sustained release nicotinic acid. It used to be available as brand name Niaspan in Thailand but is now off market, but various brands can be purchased form iHerb as "nutritional supplements" (make sure it is the sustained release form) 

Unfortunately Niacin is not as effectic as statins.

Also it might lower only LDL but increase HDL. I would not recommend this way. Maybe fibrates will help (though somehow outdated)

[teeyai]

That,s really interesting to Me as i,ve been on Statins for 3 years now and have been Back and forward to the doctors having so many issues with nerve pains but never put the two together . Plus the Doctors have never mentioned that as a possibility. I,m Definitly gonna look into the possibility further.

[KhunLA]

2 hours ago, nickmondo said:

looking at your numbers, i would NEVER have taken statins.  Your numbers are not high.  Check out research on this.  Statins cause more harm than good

Agree totally 

[TheFishman1]

I had the same problem and guess what there’s the easy solution I think it’s called CQ 10 I take two a day and now I’ve absolutely no pain in my legs or anywhere else when I first explain this to my doctor and a private hospital he really never heard of it but after taking it For a month or two went back to see the doctor and he asked me how my pain was and I told him it was totally gone now my insurance company covers that 100% but there are many different things when you feel pain from a statin that you can do to relieve it 

[dlclark97]

Try BNH (Bangkok Nursing Hospital, Convent Road), Dr Nopparat.  Chief of Cardio Metabolic Dept.  Been my Dr several years.  I have had good doctors in the USA, but he outshines them all.

[Sheryl]

2 hours ago, Carlotta said:

Unfortunately Niacin is not as effectic as statins.

Also it might lower only LDL but increase HDL. I would not recommend this way. Maybe fibrates will help (though somehow outdated)

Fibrates lower triglycerides more than LDL. (and are still widely used, I would not call them "outdated")

 

The HDL raising effects if Nicotinic acid is considered a positive benefit. 

[Sheryl]

2 hours ago, newbee2022 said:

Bempedoic acid might be an option. Try it. Side effects sometimes allergic reaction. I suppose you'll find a doc in Bangkok Int. Hospital. Docs trained abroad should know about these tablets.

Not available in Thailand. 

[xtrnuno41]

Genetic high cholesterol, harsh. At least you already lost 5 kg, so keep up.

New medicine, I guess you read also about that medicine and yes it says replacement for statines.

https://en.wikipedia.org/wiki/Bempedoic_acid

However there are again side effects, as is with many medicines.

I wonder if you could call it medicines, they work one way and destroy other way.

At least pay attention on your body, changes.

[Sheryl]

4 hours ago, nickmondo said:

Statins cause more harm than good

 

 

Absolutely untrue as a blanket statement.

 

There are individuals for whom it is true, of course, as is the case for most medications. 

 

For people at elevated risk of a coronary event who tolerate statins well, definitely does good. 

[newbee2022]

1 hour ago, Sheryl said:

Not available in Thailand. 

Get it from outside with prescription

[Sheryl]

post linking to unreliable source removed.

[mania]

On 3/17/2024 at 5:46 AM, CanNot said:

Doctor said last options are PCSK9 Inhibitors but I hesitate as its a injection and I cant just stop it like tablets if I got side effects from it.

 

Actually you take the injection every two weeks so you could stop & that is the duration.

But really it is well tolerated & based on something some folks have naturally

Peter Attia who is quite well known in this field has been on it himself for many years

Is it even available in Thailand though?