Lipitor

[Lost in LOS]

I take lipitor 10 daily. Very expensive. I read where the license is up and they now have a legal generic version [ Atorvastatin??]. Do they have it in Thailand? Anyone know a place in Pattaya. I tried a couple but they didnt know what I was talking about.

[Penkoprod]

Lipitor and Atorvastatin are one and the same

Other brands of statin ARE availible, though:

http://www.statinanswers.com/types.htm

HTH

Penkoprod

[lopburi3]

MMIS seems to indicate availability of two others in Thailand

Atorsan

Atorvastatin Sandoz

[orchis]

lipitor (atorvastatin) never worked for me, while simvastatin generic at 10 mg brought cholesterol down from 380 to 163.

[Mobi]

My doc, (specialist in then UK), switched me from Lipitor to Bestatin, (Simvastatin 40 Mg), many years ago and it has been very effective in keeping my cholesterol levels low.

The cost is 204 Baht for a box of 30 tabs or just over 6 Baht per tab.

[elektrified]

MMIS seems to indicate availability of two others in Thailand

Atorsan

Atorvastatin Sandoz

lop is correct. You can now purchase a generic version of Atorvastatin (Lipitor - Pfizer) in Thailand. Like he said, there are two choices: Atorsan which is manufactured in Slovenia and marketed through GPO and the Sandoz generic version. The GPO brand is the cheapest, Sandoz in the middle and of course Pfizer brand the most expensive.

[Lost in LOS]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

thanks for the help

[elektrified]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

thanks for the help

Keep shopping around. I paid about 40% less than that for 100 X 10 mg.

[Lost in LOS]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

thanks for the help

Keep shopping around. I paid about 40% less than that for 100 X 10 mg.

was this in Pattaya or Bangkok? Where did you get them. Thanks in advance

[ThaiPauly]

My doc, (specialist in then UK), switched me from Lipitor to Bestatin, (Simvastatin 40 Mg), many years ago and it has been very effective in keeping my cholesterol levels low.

The cost is 204 Baht for a box of 30 tabs or just over 6 Baht per tab.

My doc, (specialist in then UK), switched me from Lipitor to Bestatin, (Simvastatin 40 Mg), many years ago and it has been very effective in keeping my cholesterol levels low.

The cost is 204 Baht for a box of 30 tabs or just over 6 Baht per tab.

Agree with Mobi, I switched to Bestatin from Lipitor and it works fine for me too

[elektrified]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

thanks for the help

Keep shopping around. I paid about 40% less than that for 100 X 10 mg.

was this in Pattaya or Bangkok? Where did you get them. Thanks in advance

Chiang Mai.

[Lost in LOS]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

thanks for the help

Keep shopping around. I paid about 40% less than that for 100 X 10 mg.

was this in Pattaya or Bangkok? Where did you get them. Thanks in advance

Chiang Mai.

just read where there is a lot of counterfeit atorsan in the states now. I hope the stuff I brought is real, no real way to tell I guess

[Naam]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

Atorsan 10mg "Foodland" is the way to go!

[Lost in LOS]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

Atorsan 10mg "Foodland" is the way to go!

thats where i got it. thank you kind sir. Good results on blood, no wonder I dont get salami sandwiches anymore, cant eat them and get good results like that

[Naam]

got Atorsan 10mg at the foodland store pharmacy. 2700 baht for 100, 1/2 price of the lipitor

Atorsan 10mg "Foodland" is the way to go!

thats where i got it. thank you kind sir. Good results on blood, no wonder I dont get salami sandwiches anymore, cant eat them and get good results like that

actually the contrary applies. no day without three breakfast eggs. no week without a huge amount of shrimps and big amounts of ham and smoked sausages sent by my brother from Germany. for no valid reason i reduced last year the intake of [generic] Lipitor for six months. result: my cholesterol shot up. now sticking to my 10mg!

p.s. look at my liver functions! a few years ago i was worried that my intake of Port (and other similar goodies) might cause problems. then i was told "your functions are equivalent to those of a baby which is breast-fed by a lady who is on active duty for the Salvation Army and the Alcoholics Anonymous."

[CaptHaddock]

Statins are very dangerous. I took lipitor for five years at the end of which I had shooting pains down my arms that would wake me up at night. Turns out that niacin is more effective at controlling cholesterol, cheaper, over-the-counter, and safer. Niacin has worked very well for me for the last 5 years.

Recent, research, reported on in the NY Times, shows the risk of muscle pain and weakness is higher than thought for people who exercise:

More than 20 million Americans are taking statins, and by most estimates, at least 10 percent of them will experience some degree of muscle achiness or fatigue. That proportion rises to at least 25 percent among people taking statins who regularly exercise, and may be 75 percent or higher among competitive athletes.

http://well.blogs.nytimes.com/2012/03/14/do-statins-make-it-tough-to-exercise/?scp=1&sq=lipitor

%20exercise&st=cse&gwh=4FC4F18120D01E5EEFA1143EAC1B5963

My own lipitor pain started the year I began a walking regimen of 30 miles per week and lost 35 pounds. It it fits the case cited. I would never take a statin again.

[Naam]

Turns out that niacin is more effective at controlling cholesterol, cheaper, over-the-counter, and safer. Niacin has worked very well for me for the last 5 years.

mileages do vary. i took Niacin years ago to control cholesterol. it made me feel sick and had no effect.

[bunnaag]

Simvaststin 20 mg works also good for me.But I will try Atorsan 10mg for a while.

[CaptHaddock]

Turns out that niacin is more effective at controlling cholesterol, cheaper, over-the-counter, and safer. Niacin has worked very well for me for the last 5 years.

mileages do vary. i took Niacin years ago to control cholesterol. it made me feel sick and had no effect.

There are some formulations of niacin that are known not to be effective, but which are heavily marketed, such as inositol hexanicontinate. Most studies show that it has no benefit, but I know of at least one case where an uniformed doctor recommended it. I use a mail order product from the US:

http://www.endur.com/index.cfm?fuseaction=shopping.display&subcatid=2&pageid=2&parentid=2&parentpage=0

It has been around for years and was used in the studies that originally established Niacin's effectiveness. There is also a US prescription version called Niaspan, that I have never used, but am pretty sure is effective. There is a prescription version here in Thailand that has a similar name, but I don't know anything about it.

The other important consideration is dosage. Here I am talking about dosage levels of timed release niacin, not immediate release which is different, although also effective. Like a lot of meds there is a threshhold effect. So, I started with 1500 mg daily of Niacin (enduracin) daily and immediately achieved acceptable levels of lipids. However, then I cut it down to 1000 mg daily to see if that was enough. My lipid levels returned almost completely to the untreated levels. So, I resumed the 1500 mg/day and my measurements are usually in the optimal range, occasionally just in the acceptable range. I limit my diet pretty much and exercise daily.

As you may know, in addition to lowering LDL Niacin raises HDL levels, which statins do not. Low HDL is a separate risk factor. The guy who did the original studies showing Niacin's effectiveness, Dr. William Parsons, wrote a book, "Cholesterol Control Without Diet" which you can buy cheap from a place like abebooks.com. He is an advocate, but at least he is not a drug company.

Although Niacin is effective and does not have serious side effects like the statins, many people do experience "flushing", a feeling of warmth on the face or torso. Some people cannot tolerate the sensation. I have it from time to time, but for me it is just not a problem.

Good luck.

[Lost in LOS]

I looked on the net about niacin. Has many problems if your not careful with the dose. Most recommended multiple B instead

[lopburi3]

Other possible side effects include:

• Upset stomach
  
• Headache
  
• Dizziness
  
• Liver damage
  
• Increased blood sugar
  

However, your doctor may be able to find the right dose and form of niacin that minimizes side effects. Also, taking niacin with food may help prevent side effects. Remember, don't take niacin — even in the over-the-counter form — without discussing it with your doctor first. Niacin can cause side effects when taken in high doses.

You may have heard that a large study that examined the effect of niacin to raise HDL cholesterol was stopped early. This study examined how niacin worked when used with statin medications for people who have a history of heart disease. The trial was stopped because no difference was seen between people who took prescription-strength niacin and people who took a placebo. The study also found there may be a small increase in the risk of stroke for people who take niacin to increase their HDL cholesterol level. More research is necessary to see how effective niacin might be compared with other heart disease medications. You shouldn't stop taking niacin unless you get your doctor's OK. Talk to your doctor if you're concerned about taking niacin.

http://www.mayoclinic.com/health/niacin/CL00036

[CaptHaddock]

Other possible side effects include:

• Upset stomach
  
• Headache
  
• Dizziness
  
• Liver damage
  
• Increased blood sugar
  

However, your doctor may be able to find the right dose and form of niacin that minimizes side effects. Also, taking niacin with food may help prevent side effects. Remember, don't take niacin — even in the over-the-counter form — without discussing it with your doctor first. Niacin can cause side effects when taken in high doses.

You may have heard that a large study that examined the effect of niacin to raise HDL cholesterol was stopped early. This study examined how niacin worked when used with statin medications for people who have a history of heart disease. The trial was stopped because no difference was seen between people who took prescription-strength niacin and people who took a placebo. The study also found there may be a small increase in the risk of stroke for people who take niacin to increase their HDL cholesterol level. More research is necessary to see how effective niacin might be compared with other heart disease medications. You shouldn't stop taking niacin unless you get your doctor's OK. Talk to your doctor if you're concerned about taking niacin.

http://www.mayoclini.../niacin/CL00036

As stated the study in question was about a combination of niacin with a statin, Vytorin, whose endpoint was a reduction of HDL. The test did not achieve the endpoint. However, the purpose of the test was NOT to evaluate niacin alone or any other effects of the combination of the statin and niacin.

Of course, there are other possible side effects of taking niacin as you mention. I monitor my liver functions every time I get a blood test. They are normal. If you look at the literature on liver effects, there seem to be very few cases of serious damage due to niacin. I don't know about the frequency of the other side effects, but I have not experienced any of them.

The risk profile of lipitor and the other statins hardly looks more inviting. 10% of lipitor users experience muscle pain or weakness. That's me. However, among those who exercise the number rises to 25% and up to 75% for competitive athletes as reported in this NY Times article:

http://well.blogs.nytimes.com/2012/03/14/do-statins-make-it-tough-to-exercise/?scp=1&sq=lipitor%20side%20effects%20memory&st=cse&gwh=BEF2FA910D62F3A4EAD54FF40ACB12F4

The Food and Drug Administration (FDA) added new safety warnings to cholesterol-reducing statin drugs on Wednesday, noting increased risks of Type 2 diabetes and memory loss for patients who take the medications. ... The FDA said that statins may increase users’ risk of brain-related effects like memory loss and confusion. The reports have generally not been serious, however, and the symptoms go away once the drug is stopped, the agency said.

http://healthland.time.com/2012/02/29/fda-warns-statin-users-of-memory-loss-and-diabetes-risks/

As for the effectiveness of niacin on its own you can search the literature as well as I can. Here's the conclusion from one published paper:

Patients initially treated with lovastatin had higher baseline mean cholesterol and low-density lipoprotein (LDL) levels as well as higher rates of diabetes mellitus and heart disease than did patients initially treated with niacin.

You can look it up on PubMed.org:J Fam Pract. 1997 May;44(5):462-7.

Relative effectiveness of niacin and lovastatin for treatment of dyslipidemias in a health maintenance organization.

O'Connor PJ, Rush WA, Trence DL.

Source

HealthPartners Group Health Foundation, Minneapolis, MN 55440-1309, USA.

Here's a quote from another review that focused on niacin alone:

Fibrates and niacin have been shown to improve atherogenic dyslipidemia in clinical trials. Niacin effectively lowers triglycerides, raises HDL cholesterol, and shifts LDL particles to a less atherogenic phenotype (phenotype A). The various niacin formulations available differ in terms of safety and efficacy. When administered alone or in combination with other lipid-modifying agents, niacin prevents progression and promotes regression of coronary atherogenic lesions and reduces coronary risk.

Am J Manag Care. 2002 Sep;8(12 Suppl):S315-22.

Niacin-based therapy for dyslipidemia: past evidence and future advances.

Ito MK.

Source

Southern California Clinical Experience Program, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, USA.

Here is the side effect warning from one online vendor of lipitor, which is not complete since it doesn't even mention memory loss:

There are a number of side effects with Lipitor that you should report immediately to your healthcare provider. These include, but are not limited to:

Signs of liver damage, such as yellow eyes or skin, upper right abdominal pain, dark urine, and elevated liver enzymes.

Muscle pain, tenderness, or weakness, especially if you also have a fever or feel ill, since these may be signs of serious breakdown of muscle, known as rhabdomyolysis.

Significant, unexplained changes in the amount of urine you produce (which may be a sign of kidney problems)

Signs of an allergic reaction, such as:

A rash

Itching

Hives

Wheezing or difficulty breathing

Swelling of the mouth, tongue, or throat.

There are a number of side effects with Lipitor that you should report immediately to your healthcare provider. These include, but are not limited to:

Signs of liver damage, such as yellow eyes or skin, upper right abdominal pain, dark urine, and elevated liver enzymes.

Muscle pain, tenderness, or weakness, especially if you also have a fever or feel ill, since these may be signs of serious breakdown of muscle, known as rhabdomyolysis.

Significant, unexplained changes in the amount of urine you produce (which may be a sign of kidney problems)

Signs of an allergic reaction, such as:

A rash

Itching

Hives

Wheezing or difficulty breathing

Swelling of the mouth, tongue, or throat.

[CaptHaddock]

Here are some snips from the NY Times article that appeared following the early termination of the Pfizer study:

“There’s a great unfilled need for something that raises HDL,” said Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic and president of the American College of Cardiology. “Right now, in the wake of the failure of torcetrapib, niacin is really it. Nothing else available is that effective.”

In 1975, long before statins, a landmark study of 8,341 men who had suffered heart attacks found that niacin was the only treatment among five tested that prevented second heart attacks. Compared with men on placebos, those on niacin had a 26 percent reduction in heart attacks and a 27 percent reduction in strokes. Fifteen years later, the mortality rate among the men on niacin was 11 percent lower than among those who had received placebos.

“Here you have a drug that was about as effective as the early statins, and it just never caught on,” said Dr. B. Greg Brown, professor of medicine at the University of Washington in Seattle. “It’s a mystery to me. But if you’re a drug company, I guess you can’t make money on a vitamin.”

http://www.nytimes.com/2007/01/23/health/23consume.html

[lopburi3]

“Here you have a drug that was about as effective as the early statins, and it just never caught on,”

I suspect a major reason was most people were getting extreme hot flash reactions to the niacin of that period (I know for a fact my parents did). For many the statins are a lot less uncomfortable. But for you this is not the case. Just as we Americans have Jiff and Skippy for our daily fat supply one size may not fit all - but does not necessary make one or the other the magic pill.

[CaptHaddock]

“Here you have a drug that was about as effective as the early statins, and it just never caught on,”

I suspect a major reason was most people were getting extreme hot flash reactions to the niacin of that period (I know for a fact my parents did). For many the statins are a lot less uncomfortable. But for you this is not the case. Just as we Americans have Jiff and Skippy for our daily fat supply one size may not fit all - but does not necessary make one or the other the magic pill.

"Magic pill" is not part of my vocabulary. I doubt if it is part of yours, other than for the occasional straw man argument. So, maybe we can dispense with the rhetorical flourishes and focus on the facts.

I doubt very much if widespread intolerance of the harmless, but unpleasant, flushing effect discouraged the adoption of niacin. No one among the many high cholesterol people I know was ever offered the option of taking niacin. None of them had ever heard of it. I think the pre-emption of niacin treatment by statins is most likely due to the following, your parents' exceptional experience notwithstanding:

1. drug companies do not promote niacin because it can't be patented and therefore will always have a low profit margin

2. without the backing of drug companies relatively little testing of niacin is sponsored

3. because of the first two reasons statins have become established as the standard treatment. Doctors now have little incentive to deviate from the standard treatments because it exposes them to litigation risk, a big concern for doctors whose personal assets are never protected by the corporate veil. (This was the reason given to me by my own ex-doctor.)

Very far from suggesting that everyone with high cholesterol should take only niacin, I think every doctor facing such a patient should offer the choice by presenting this information to the patient:

There are two classes of medication, statins and niacin, both of which are effective at lowering cholesterol. Niacin reduces some additonal risks that statins do not.

A daily does of 1500 mg niacin costs about 24 cents and is available over the counter, but may not be covered by insurance. Pharmaceutical grade is also available and probably would be covered by insurance.

A daily dose (20 mgr) of lipitor costs $5.50 at drugstore.com, but if you have insurance coverage it may be much less.

Both drugs have the possibility of side effects. Niacin may cause flushing that is harmless and diminishes during the first month, but is not tolerated by some people. Seriously harmful side effects from niacin are very rare.

Statins usually have no side effects, but some side effects are very common. Muscle pain and weakness is experienced by 10% of the users or more. Rates of myopathy increase with exercise so statins would not be recommended for those who exercise regularly. Some users also report memory loss and/or loss of mental clarity.

Now you, the patient, has the information you need in order to decide which you prefer, based on your own risk/reward preferences.

I have never heard of any doctor presenting the choice to a patient in this way. I know how I decide: cheaper, safer, better is good enough for me.

The only magic pill is full information.

[lopburi3]

Niacin at that time and at the level required for benefit was a very unpleasant experience for many (if not most) of those being treated.

[cheeryble]

I have a thread just started:

Cholesterol Myth-Are Cardiologists Really Wrong?

....and would be interested if anyone can provide good information as to why they presume they need to lower their cholesterol......apart from simply "doctor's orders".....in that thread.

thanks Cheeryble

[Naam]

..and would be interested if anyone can provide good information as to why they presume they need to lower their cholesterol...

to avoid on november 21, 2008 open heart surgery (4 coronary bypasses, 1 aorta bypass), cost surgery and 8 days hospital €UR 48,000, two weeks rehab-clinic €UR 7,200, two business class tickets BKK-MUC € 4,850, surcharge for the only "suite" in the hospital €UR 5,600 (add. bedroom for the Mrs), 2 weeks hotel for the Mrs €UR 3,080, taxi, phone and sundry expenses ~€UR 1,500...

total cost €UR 70,230 = Thai Baht 3,511,500 using average exchange rate oct/nov 2008

notwithstanding the fact that the lion share was reimbursed by my private german health insurance all cost and trouble could have been avoided if i had followed 20 years ago the advice of my doctor to take cholesterol lowering medication.

bailiff... next case!

[Naam]

Niacin at that time and at the level required for benefit was a very unpleasant experience for many (if not most) of those being treated.

a bit like taking Viagra now. it caused burning ears

[hhgz]

Interestingly, the Dr. Oliver Clinic report has the Rod of Asclepius printed upside down. Ah, Thailand!