My answer:

Hi!  These lab results can be really confusing   A general rule of thumb for most patients to figure out your cholesterol is…
Total Chol = LDL + HDL + (TG/5)
so… if LDL =120
HDL = 40
TG =140
total chol = 188

So, yes, it can happen. Just so you know, TG =140 isn’t a bad reading. Also, even though guidelines say that you do not need to fast for a cholesterol test…trigylcerides can be affected by what you eat before you get the test.

I hope this clears it up a bit for you -if you have any more questions or questions about other lab values -just drop us a line

Question: My father in law  takes a lot of medication and we are concerned that no one is keeping an eye on the big picture to make sure the medicines are all compatible.  The list of what he takes is below.  Are you aware of any possible problems associated with this combination of drugs. 
Glyburide 5mg Take 2 tablets twice a day.   Metformin 500mg Take one tablet twice a day   Simvastatin 40mg take one tablet once a day. Cozaar 50 mg take one tablet daily . Doxazosin 4mg   take one & half tablet at bedtime.
Thanks!

Here is my response:

Hi!  Thanks for contacting us!

Glyburide 5mg -2 tablets twice a day–Diabetes
Metformin 500mg -one tablet twice a day–Diabetes
Simvastatin 40mg -one tablet once a day –Cholesterol
Cozaar 50 mg -one tablet daily –Blood Pressure/kidney protectant
Doxazosin 4mg- one & half tablet at bedtime –BPH/ Blood Pressure

There aren’t any major interactions here.  Use of Cozaar, Doxazosin and Glyburide together can increase risk of blood pressure and blood sugar being too LOW.  This is easily monitored with testing blood pressure and sugar.
Also, he can monitor how he feels -low blood pressure: dizzy, fatigue, light-headed especially upon standing up.  Low blood sugar -light-headed, dizzy, sweating, headache.

He may want to consider adding…
1.  OTC CoEnzyme Q10.  This will help replace the CoQ10 that is decreased from the simvastatin.
2.  OTC B12 (or B-complex).  This will replace the B12 that is decreased from metformin
3.  Talk to physician about adding OTC calcium and vitamin D supplements -for general health and to counteract calcium depletion by Cozaar.

Lastly, are these medications working for him?  Are they controlling his
blood pressure, cholesterol and blood sugar/ A1c?

Hope this helps!  Please contact us with any questions/comments.

There you have it!  Of course, this is quite specific for this patient but if you have questions about your or your family member’s medications -please leave us a comment, submit a question or send an email at nova@getpharmacyadvice.com .

Just wanted to inform you of the effects oral contraceptives (aka birth control, the pill, etc.) can have on your cholesterol levels.

Check it out below!

The progestin name I was trying to pronounce was norethindrone!

Let’s keep this discussion going…leave a comment below or send me a message at Cate@getpharmacyadvice.com.

Have a great week!

After reviewing results from the major clinical trial called SEARCH and going over information from other sources (i.e. adverse event reports),  the FDA has issued a warning to the public and healthcare professionals that the highest approved dose of simvastatin, 80mg daily, can cause an increased risk of muscle injury compared to patients taking lower doses of simvastatin or other “statin” medications.

Symptoms of muscle injury you should look out for while taking high-dose simvastatin, or any “statin” for that matter, are muscle pain, weakness, or tenderness.  If your blood is drawn, the test results are likely to show an increase in a particular muscle enzyme, creatine kinase. 

The higher the dose of simvastatin, the higher the risk of muscle injury (aka myopathy)!  There is also an increase risk of muscle injury when simvastatin is taken with certain other medications, escpecially at the increased dose of the cholersterol-lowering medication. 

Follow these dose limitations for simvastatin, and you should be able to decrease your risk of muscle injury (got this list from the FDA’s website):

Do not take simvastatin at all if you are taking:

• Sporanox (itraconazole)
• Ketoconazole
• Erythromycin
• Clarithromycin
• Ketek (telithromycin)
• HIV Protease Inhibitors
• Nefazodone

Do not take more than 10mg of simvastatin if you are taking the following medications:

• Gemfibrozil
• Cyclosporine
• Danazol

Do not take more than 20mg of simvastatin if you also take:

• Amiodarone
• Verapamil

Do not take more than 40mg of simvastatin if your medication list includes:

• Diltiazem

Do not stop taking your simvastatin without first speaking to your physician, but please make sure you contact them as soon as possible if you feel you are experiencing symptoms of muscle injury or if your dose falls outside the abovementioned limitations. 

If I were you and was currently taking simvastatin 80mg once a day, I would make an appointment with my physician to see if they’d be willing to switch your high-dose simvastatin to a lower dose of another more potent “statin” like Lipitor.  With this change, your cholesterol levels will remain under control and your muscles will be happy because they will be at lower risk of injury! 

Ever experienced muscle injury due to high-dose simvastatin?  Confused about whether you should contact your physician based on your simvastatin dose?  Need more clarity on this matter? Leave a comment below and we can help you out. 

Please check out our video course on how to save money on your prescription medications -it will be helpful if your simvastatin is changed to Lipitor.  Plus, it’s available to you at no charge!  Can’t beat that!