Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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Should I Quit Statins and Switch to OTC Meds?

Thursday, 19 Aug 2010 08:43 AM

Question: There are many over-the-counter medications for lowering cholesterol. Should I switch to them instead of using statins to avoid so many side effects?

Dr. Hibberd's Answer:

If you can use diet to control your cholesterol with the addition of a high-fiber diet, you do not need the aid of prescription medication. Many of us have LDL goals as low as under 100, and even as low as 80, that are practically impossible to meet without using a statin or other prescription drug.

I prefer the statins for their ease of use, relatively safe side effect profile, and minimal interactions with other drugs. In my opinion, these characteristics trump over-the-counter options. Not that equivalent control is not possible with diet and carefully chosen over-the-counter medications, I still prefer the ease of use the statins offer.

The side effect profile of the over-the-counter medications are fine for the lower doses, but atrocious for the higher doses required for effective control goals to be met.

I now consider over-the-counter options that include niacin and psyllium and other sources of soluble fiber to be effective adjuncts or additions for those wishing additional control over and above their statin use. There was a time I used them before using statins, but not now.

Statins are the clear No.1 choice of most knowledgeable medical professionals for themselves and their patients. The facts show that statin drugs are much safer than initially reported when they came out years ago. The scare tactics I see on Internet sites reporting devastating side effects of death, renal failure, liver failure, diabetes, muscle damage, and memory loss are actually very uncommon. The vast majority of patients love the statins in every way except their relatively high cost.

The only secret I have found that needs more publicity is the suggestion to add CoQ10 to your daily regimen when you take a statin medication. This addition helps prevent nuisance muscle aches that are often reported.

Yes, there are some patients who shouldn't use statins, and some drug combinations that should be avoided. Yes, grapefruit juice is not a wise selection for you if you are using statin medications. Yes, statins should be discontinued and your doctor consulted if muscle aches develop.

There have indeed been rare serious side effects with statin use, just as with any medication, but few that are not reversible by discontinuing the drug. To put this in better perspective, I have actually found more nuisance — and sometimes serious — reactions to antibiotics and pain reliever medications than I have to statins.

There are thousands who have benefited by statin use compared with many, many thousands more who had tried the previously available medications before the advent of statins and literally given up their hope for lipid control because of side effects or unpalatable combinations.

Since the advent of statins, we have seen an over 10-fold improvement in lipid management compliance and ease of goal maintenance compared with meds available before statins.

Previous drugs were far more toxic, or were prone to side effects, or were simply unpalatable, difficult to use, or very difficult to stay compliant with over the long-term.

Let's face it: Statins save lives and immensely reduce the re-occurrence of heart disease and stroke. Statins have permitted many to reach their lipid-management goals comfortably and simply with a medication taken once a day! Many a doctor and cardiologist are taking statin medication themselves because of their wish to reduce their cardiovascular risk. I believe that speaks for itself.

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