Dosage query

[Davidc1075]

I had problems with 40mg Atorvastatin causing muscle and joint pains. The doctor has prescribed 5mg of Rosuvastatin instead. Reading the NHS web site it says up to 20mg for high cholesterol and mine is very high. Does the dose seem right I appreciate different medications will have different doses. Thanks for any advice before I approach the doctor or pharmacist.

[Davidc1075]

I had read that but I have been given a months dose of 5mg will no blood test booked to see where my levels are at the end of the month so how could the doctor make an informed decision. Should I book another blood test do you think ? Maybe I'm making an issue out of nothing but my prescription slip says 5mg for 12 issues.

I have little faith in the GP unfortunately so do others here book their own blood tests to see where levels are ?

[Hidden in reply to Davidc1075]

As understand it it takes a few weeks for the full effect of the statin to settle down and then a blood test can be taken and at that point the dosage can be adjusted. Remember that statins are given for reducing long term heart disease risk so a few weeks when the statin dose has not been optimised will really make little difference to you. In short there is no need to rush things.

[Davidc1075 in reply to Hidden]

I was just very shocked to be told my figures went from being very good to very bad over a couple of years. Changed my life style completely no alcohol, no caffeine, cakes biscuits etc and no ready made meals or red meat lots of exercise. Now mainly veg chicken and fish together with two items of fruit. I just want to see the hard work I'm doing to be outdone by the statins or matched at least. Thanks for your reply 👍

[Hidden in reply to Davidc1075]

Nearly 25 years ago I found out my total cholesterol was over 9. I am likely to have the genetic linked problem but have never been tested for it, since that wasn't done back in the day. Anyway like you I opted for lifestyle changes and the best I ever got was 6.5. But my diet was a miserable existence, causing all sorts of problems for my wife and I preparing food and so I had started to slide back and when my cholesterol got to just under 8 I started statins. And my cholesterol dropped to about 5. And I have taken statins ever since. So do try the lifestyle only route but be aware it is for life and any lapses only will serve to increase you heart risk going forward.

[Davidc1075 in reply to Hidden]

I'm just trying to give myself the best results so more than happy to take statins just surprised its been prescribed at such a low dosage. As for diet yes pretty boring but one cheat night a week which is tonight. 2 months in and 10kg gone only 40 to go 😂 best wishes

[Hidden in reply to Davidc1075]

I lost 13kg last year to get me at the bottom end of 'overweight' BMI and then returned the best annual total cholesterol reading likely ever of just under 4. My GP agreed with my suggestion that weight loss had played its part.

[Davidc1075 in reply to Hidden]

Well done to you any top weight loss tips or hidden foods my diet is so boring sometimes dont want to eat 😀

[Hidden in reply to Davidc1075]

I had a varied mixed 'healthy' diet, and indeed still have. I didn't eat much sugary stuff, but was a beer drinker, probably too much, and was partial to crisps and speciality cheeses. I also couldn't exercise at the beginning of last year because I had plantar fasciitis. But after a heart health scare (which turned out to gastro related after all), I cut out the remaining occasional cakes and biscuits and cheese and biscuits after dinner etc and stopped the crisps and substituted proportionally less wine for beer. Plus I started to walk again, like everyday when I can, I walk about 2 miles. Otherwise not much else was different. And the weight slowly came away over about 3 months and I might have gained a kilo since my lowest weight but that's it.

[Davidc1075 in reply to Hidden]

I have plantar fasciitis which seems to rear its ugly head just when I'm getting into my stride pardon the pun and clicking up those steps. Hopefully a second hand bike will be better and easier on the foot and joints in general. My nemesis was white wine so cut it out completely. I do tend to eat alot of fruit but am.now watching it as I end up eating the whole punet. Thanks for the advice 👍

[Smitty1956 in reply to Davidc1075]

If Thatwasunexpected is correct (and he likely is correct), then 5 mg of your current medication is roughly equivalent to 40 mg of Atorvastatin, which you had been taking. I think that I would try to give that dosage of the new medication a chance for awhile to see how it works. You have additionally made major changes in your diet and overall lifestyle.

I had my HA in March 2022 (one year ago). The cardiologist at the hospital immediately put me on 80 mg of Atorvastatin. I hate taking drugs—especially high doses of drugs—so I discussed this with my GP. We both agreed that I could try 20 mg of Atorvastatin instead. I stayed on this dose for about 2-3 months plus I made lifestyle changes in diet, etc. Finally, I saw a new cardiologist in May, and she got me to try a higher dosage of Atorvastatin—40 mg. She had wanted me to take 80 mg., but I still wanted a lower dose. She also increased my beta blocker dosage, and I slowly got to feeling better by July. I did not get a follow-up blood test for 11 months after the HA and taking statins. By that time, my cholesterol levels were much lower. My point is that from the beginning, I was arguing to take lower dosages of all of my drugs, and I was probably wrong. I should have tried the 80 mg of Atorvastatin after the HA, and then the dosage could have been lowered later.

You may be over worrying the 5 mg. dosage for now. Talk with your doctor, but you might want to give the 5 mg dose a chance to work. I believe that the dosage could be increased later if needed. I think that both lifestyle changes and statins take awhile to show/produce changes in your system.

I know that all of this is worrying and scary, but you have got this.

[Davidc1075 in reply to Smitty1956]

Thank you Smitty it was another wake up call one which I have now headed. Just want to get the best chances

[Chappychap in reply to Davidc1075]

"do others here book their own blood tests to see where levels are ?"

Yes, I augment my annual NHS blood test with private six monthly tests. I also add in a couple of additional tests to identify markers for stress and inflammation. Comes to a couple of hundred pounds, a lot less than servicing my car!

But in truth this hasn't really influenced medical outcomes, it's more to satisfy my own curiosity. In my case at least the NHS seems to have got their cardiac care protocols pretty well sorted.

Going back to your circumstances. Persistently high cholesterol is a serious risk factor. In your situation I'd be asking if some joint discomfort wasn't a price worth paying. Five years on and I've still got the "Ramipril cough", some side effects we just have to accept.

I'd also want to know if there was a genetic cause for high cholesterol. If there was genuine family evidence then I'd either test privately (I had a suite of private heart related DNA tests done, it cost about £500 four or five years ago, sounds a lot but you only ever have it done once and the results are also relevant to all your close blood relatives) or discuss with my GP having NHS DNA tests. FH is the only heart condition where the NHS will authorise genetic testing.

Finally I'd want to look at some of the recent breakthrough new cholesterol drugs such as Inclisiran, and discuss with my GP if these might be appropriate.

Good luck!

[Davidc1075 in reply to Chappychap]

I've got the ramipril cough tpo but comes and goes. As to the blood tests where do you recommend please. I will continue with the NHS ones as well bit after putting so much effort and changing my lifestyle completely I want to see of the changes and meds are going in the right direction a little quicker. Will discuss with the GP about Insiliran and Sljp0000 also mentioned one. Best wishes and please get back to me on the blood test for my cholesterol 👍

[Chappychap in reply to Davidc1075]

I've had private blood tests with Medichecks, Nuffield Health, and Spire Hospitals. Each equally satisfactory.

Good luck!

[Hidden in reply to Chappychap]

You have to jump through several hoops before you get prescribed Inclisiran, one being that your LDL levels are consistently higher than 2.6 even with statin treatment. And even I don't qualify with a natural total cholesterol of 9+ and with max dose statins rarely going below 4 for total cholesterol.

More here

nice.org.uk/guidance/TA733/...

As for FH genetic testing I have never been offered it, although when I started taking stains nearly 25years ago I doubt if it had been invented. 😆

[Chappychap in reply to Hidden]

Hopefully you'll get one of the new cholesterol wonder drugs like Inclisiran before too long.

Good luck!

[memees in reply to Davidc1075]

HiUnfortunately, you have to go through your gp they book tests hand into reception but you have to request through gp. Remember they're supposed to be there to help you so request appointments. They're also who make referrals to specialists I.e. cardiologist. If you can get appointment with gp first and query everything you need to, write it down if helps! Ask them to refer to cardiologist. They're the one's who can properly assess you, do necessary tests, and monitor medications esp if changing meds and full blood tests. Make sure they record it all on your medical history record, you can even request a full copy of medical history recoord and blood test results to date, ask the receptionist can just print off for you! I did for upcoming specialist app. It was very helpful!

Good luck doctors there to help you!

All the best

[Sljp0000]

David, food has very little correlation to our cholesterol levels. Mine went up to 6.6 and the GP told me it was definitely an hereditary issue at that level. I eaten and excercised sensibly for years and still ended up with coronary artery disease. As I mentioned before, it's around 3 months before the statin has the desired effect. Wait that long then request a blood test to see how it's affected your levels. Try not to worry, you're on the right track now with this medication and a few months of waiting won't make any difference to your health if its not going as low as necessary.

Take care

Susie

[Petercat1]

Hi.I was put on 40mg of Atorvastatin and had awful reaction to them, my doctor changed me to 10mg Rosuvastatin for the first month then upped the dose to 20mg. I have now changed to Simvastatin 40mg as I was getting terrible back pain which we thought may be the statins. I was still getting the back pain so (although I was advised to stop taking them by a dr, altogether for a month to see if the back pain goes) I am taking 1/2 a tablet (20mg) now as was worried about stopping them altogether, just like that!

I personally don't like statins but the dr recommended I take them due to me already having a mini stroke.

5mg does seem a very small dose of Rosuvastatin but only your dr would know your case so please ask the dr.

Best wishes

[memees in reply to Petercat1]

HiWhen I was first put on atorvastatin and 2 other B.P medications. The gp has to book usual blood test as strong medications can affect your kidneys! Keep an eye and query blood results and medication, I still get back pain and bad muscle aches, was told side affects and affects your kidneys!

[Astronomyrules]

Hi, I have FH , There are a number of ways to lower cholesterol. Uncontrolled, my cholesterol was 13.7 despite a good diet and no weight problems. It is now 2.4. This has been gradually achieved by 20 mg Rosuvostatin, 15 mg Ezetimibe and 140mg Evocoumlab ( Repatha) self injected fortnightly. I had full blown rhabdomyolysis on Simvastatin and like you was later started on a low dose of Rosuvostatin which was titrated up to the max my body would tolerate. I understand the sense of anxiety to get your cholesterol down, but it's better to let your body adjust. Statins are vital as they also help to stabilize the plaque , I've been on them for 20 years, but other additional drugs are available if necessary, as in my case, including the newly a available 6 monthly injections mentioned others. Good luck with our cholesterol controlling journey.

[Davidc1075 in reply to Astronomyrules]

I wouldnt mind but there is little communication from the doctor he even text me to say that I had Bradycardia can you believe that. I have no idea if the medication is going to be increased over time. Good that you have now got your Cholesterol under control. Best wishes.

[Astronomyrules]

Thank you for your reply. Not having the feeling that your GP is looking out for you, is unsatisfactory to say the least. I am assuming you don't have have a cardiologist and wonder whether you could ask for a referral as in my experience the consultant will advise/ tell the doctor about medication levels and keep an eye on your blood tests. A lipidologist would be great, but I understand there are few of these on the NHS. I've never met one. All these things take time I'm afraid, but as you say your cholesterol is very high and going by my experience , you should be closely monitored until you cholesterol is at an appropriate level, although as others have said it does take around a month for the statins to properly kick in. If you are still unhappy is there any chance of changing your GP?

[Davidc1075]

Little to no chance changing GP feel blessed to pay my national insurance for 40 plus years and be lucky in a blue moon to get a telephone appointment. Had a text to say I was in Bradycardia after an ECG at the doctors told to cut down the bisoprol, nothing else, no advise nor appointment to discuss it. How about this, I was diagnosed as having AF when in ICU for a bilateral pulmonary embolism. Never seen a cardic consultant, had an ecg the day of my Cardioversion then a rushed telephone call from a consultant 2 months later to have a two day holt monitor. Did that phoned up asking to speak to the consultant and was told the results that they the Cardiac department had been sent to my gp. No update at all then because I was collapsing at home I asked for the ecg.

If I ran a buisness like this it would be bust long ago.

[Astronomyrules in reply to Davidc1075]

So sorry to hear about your negative experiences. It is clear that you feel you have been let down many times and that NHS provision is highly geographically variable. I do remember how scared and frustrated I felt with the slow speed of response when I was first diagnosed 20 years ago, but once in the system I have been well looked after. I have no experience of private care, but others have replied with information including some costs.It might be a way forward if, you can afford it. I've heard that some pharmacies do cholesterol tests. Hoping things get better for you soon.