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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18668
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My doctor put me on cholesterol meds and retested me about

Customer Question

My doctor put me on cholesterol meds and retested me about 75 days later. My number was,200 and my prescription was for 40mg of pravastatin. He then bumped my dosage to the max of 80mg and refuses to lower the dosage. My original reading prior to the first prescription of 40mg was around 247.
I've experienced lots of muscle weakness and some short term memory issues. I'm also finding it difficult to workout. I've been taking CoQ10 but that doesn't seem to help. I was obese when my numbers were the highest. I actually feel worse. What can I do differently to work with my doctor as he isn't working with me on a solution.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

To give you a complete answer, it will help if you could provide some further information.

Is the 200 (and the previous 247) the level of your total cholesterol or your LDL cholesterol?

If it is the total cholesterol, what is your LDL cholesterol?

Do you have heart disease or any other chronic medical conditions?

Has a CK level been checked? If so, what is the result?

Customer: replied 1 year ago.
That was total. At 247 reading, LDL was 174. At 200 reading, LDL was 125. I am on BP meds however, he is thinking about removing that since my numbers have remained very low. History of cancer on my mom's side. Just had a genetic test that showed no signs of cancer or mutations
Customer: replied 1 year ago.
Just verifying that you received my response?
Expert:  Dr. D. Love replied 1 year ago.

Thank you for the additional information. Yes, I got your response, but it takes tiem to type a complete answer. I will post what I have already typed and will finish the rest of the answer.

As you know, any of the statins can cause a problem with the skeletal muscles, called statin myopathy. There are many other causes of muscle weakness or pain, but there should be some consideration of statin myopathy when that person is taking a statin. It is also appropriate to also consider an evaluation for other causes of muscle symptoms.

The current guidelines for managing muscle symptoms in someone taking a statin recommend decision making based on the severity of symptoms and the level of CK. CK, or creatine kinase, is a muscle enzyme, and will increase in the blood when there is muscle inflammation or damage.

If there is no elevation in CK or only mild elevation in CK and the muscle symptoms are tolerable, it is recommended to continue the statin, while monitoring symptoms and CK levels. If there is moderate elevation in CK or the muscle symptoms are intolerable, then it would be reasonable to stop the statin for a short period and then resume a statin once the symptoms improve. If the CK is severely elevated, i.e., 10x the upper limit of the normal range, that is considered a severe elevation, and the statin should be stopped and the use of statin reassisses.

I ask about the clinical situation, because the current guidelines for use of statins are that statins should be used for everyone with nown cardiovascular disease, in someone with an LDL cholesterol above 190, in diabetics, and in someone with other clinical risk factors that increases the risk for cardiovascular disease. It is not apparent from the information that you have provided that you satisfy any of these four criteria, so it may be reasonable to reconsider whether statins are needed.

So, there are several steps that can be taken at this point. You did not comment upon whether the CK was checked, and if it was not checked, that would be the first step.

Expert:  Dr. D. Love replied 1 year ago.

If the muscle symptoms are intolerable, then it would be appropriate to consider a trial of stopping the statin. However, it would also be appropriate to rview the reason for starting the statin in the first place.

If your primary doctor is not as familiar with the indications for statin treatment or the management of statin myopathy or muscle symptoms in someone taking statins, you can try to work with this doctor, even to the point of bringing in guidelines from the medical literature. However, it is usually easier and more effective to ask for a referral to a specialist that has more experience in dealing with these issues. Many primary care physicians are well versed in managing these conditions, but if a specialist is needed, it would usually be a Cardiologist.

I am sorry for the length of the answer, but it is a complex situation.

If I can provide any further information, please let me know.

Customer: replied 1 year ago.
No worries. I had a problem with my Internet connection which is why I wanted to verify. Let me see if the results show a CK reading. My other question is why would he increase the dosage so quickly if the numbers dropped within a short period of time. Btw, I have since lost weight and will be having a recheck. Let me check for a CK result.
Customer: replied 1 year ago.
Doesn't say CK but there was a vitamin D test performed when I mentioned muscle pain and that came back normal
Customer: replied 1 year ago.
There is also a Creatinine result of .97 but not certain if that is the same
Expert:  Dr. D. Love replied 1 year ago.

Actually, that is one of the changed recommendations in the current guidelines for cholesterol management. The guidelines moved away from the goal directed treatment of the previous guidelines and instead into the four clinical criteria noted above. As part of that, the guidelines no longer recommends adjusting the dose until a goal is reached, but instead recommends high dose statin therapy for most of the above criteria, although there are one or two clinical situations in which moderate dose statins are recommended. So, in someone with one of the four clinical criteria noted above, using the highest dose of the statin is recommended, regardless of changes achieved at lower doses of the statin.

It is good that the vitamin D level was checked, as that is appropriate to look for other cause of muscle symptoms.

The creatinine is not the CK. The creatinine is also derived from muscle, but is mostly an indication of kidney function, and your creatinine level is perfect. Only the CK is meaningful in this situation.

Customer: replied 1 year ago.
Also, with both numbers, my LDL never hit 190. I will definitely question this path of treatment
Expert:  Dr. D. Love replied 1 year ago.

Correct, which is why I said above that this information does not show that you satisfy any of the four criteria.