Difference Between statins

Discussion of statins (Lipitor, Zocor, etc.) in the treatment of MS.

Postby CureOrBust » Sat Mar 11, 2006 7:17 pm

ljm wrote:can anyone point to whether statins are assumed to have effect through their anti inflammatory characteristic or through cholesterol lowering characteristic (because if its the latter, I’m on this god forsaken diet that should be as good as a Statin)


At http://www.remedyfind.com/rem.asp?id=19707, I found:

Evidence has emerged that statins, which are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, have immunomodulatory effects. Recent reports showed that statins prevent and reverse chronic and relapsing experimental autoimmune encephalomyelitis, an animal model of MS. Furthermore, in vitro experiments with human immune cells have shown an immunomodulatory profile of statins comparable to that of interferon beta. An open label clinical trial of simvastatin for MS revealed a significant decrease in the number and volume of new MRI lesions and a favorable safety profile. Statins might be beneficial for MS patients as monotherapy or as an add-on to established disease modifying drugs


So, no mention of cholesterol.
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Postby ljm » Sun Mar 12, 2006 3:33 pm

By the way, the bottle of Lipitor I got prescribed before I departed Canada for US (guessing that I would have somewhat more difficulty here finding a off-labelling doctor) has as the sole warning on label that it must not be taken with....grapefruit or grapefruit juice. Could this have been a misprint? Coincidentally, I was thinking of starting it today but this morning but just finished a delicious ...grapefruit...before digging out the bottle. I'll have to wait till tomorrow I guess. Are there any supplements that I should discontinue when using?
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Postby CureOrBust » Mon Mar 13, 2006 12:58 am

The grapefruit one made me read twice the first time, but recently i have read that the grapefruit juice actual INCREASES the statins cholesterol lowering ability.

I find it interesting that doctors would not prescribe a lower statin dose with grapefruit juice. I guess it would be a bit "out of control".

Personally, i wouldn't be too concerned about grapefruit juice you had a few hours ago. At the very least, i would be taking a half dose.
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Postby CureOrBust » Mon Mar 13, 2006 1:01 am

oops... almost forgot, in case you arent already, or havnt herd, you should look at taking CoQ10 suppliments.
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Postby CureOrBust » Tue Mar 14, 2006 2:29 am

Just to let you all know, I have now switched to Lipitor.

I have started on 40mg as the 80mg tablet was too hard to split any further.

The only thing which may throw my results out a bit is that I also started a flagyl pulse (i am on abx's as well) and it normally makes me feel a little worse for wear if anything.
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Re: Difference between statins

Postby NHE » Tue Mar 14, 2006 4:42 am

ljm wrote:By the way, the bottle of Lipitor I got prescribed before I departed Canada for US (guessing that I would have somewhat more difficulty here finding a off-labelling doctor) has as the sole warning on label that it must not be taken with....grapefruit or grapefruit juice. Could this have been a misprint?

That's unlikely. Grapefruit juice inhibits the enzyme Cytochrome P-450 which, if I remember correctly, normally breaks down certain drugs and compounds to make them less toxic. Thus, the dosage normally given is higher than it would otherwise be in order to compensate for the activity of this enzyme. Taking certain drugs with grapefruit could lead to an overdose. With drugs which have a potential to damage the liver, such as statins, avoiding overdoses is preferable. Here's a related paper which covers grapefruit and oral methylprednisolone...

Grapefruit juice can increase the plasma concentrations of oral methylprednisolone. 2002.
Eur J Clin Pharmacol. 56(6-7): 489-93.

OBJECTIVE: To investigate whether the pharmacokinetics of orally administered methylprednisolone and plasma cortisol concentrations are affected by administration of grapefruit juice. METHODS: In a randomised, two-phase, cross-over study, ten healthy subjects received either 200 ml double-strength grapefruit juice or water three times a day for 2 days. On day 3, 16 mg methylprednisolone was given orally with 200 ml grapefruit juice or water. Additionally, 200 ml grapefruit juice or water was ingested 0.5 h and 1.5 h after methylprednisolone administration. Plasma concentrations of methylprednisolone and cortisol were determined using liquid chromatography/mass spectrometry (LC/MS/MS) over a 47-h period. RESULTS: Grapefruit juice increased the total area under the plasma methylprednisolone concentration-time curve (AUC 0--infinity) by 75% (P < 0.001) and the elimination half-life (t1/2) of methylprednisolone by 35% (P < 0.001). The peak plasma concentration of methylprednisolone (Cmax) was increased by 27% (P < 0.01). Grapefruit juice delayed the time to the Cmax from 2.0 h to 3.0 h (P < 0.05). There was no significant difference in the plasma cortisol concentrations, measured after methylprednisolone administration, between the water and grapefruit juice phases. However, grapefruit juice slightly decreased the morning plasma cortisol concentrations before methylprednisolone administration (P < 0.05). CONCLUSIONS: Grapefruit juice given in high amounts moderately increases the AUC 0--infinity and t1/2 of oral methylprednisolone. The increase in t1/2 suggests that grapefruit juice can affect the systemic methylprednisolone metabolism. The clinical significance of the grapefruit juice-methylprednisolone interaction is small, but in some sensitive subjects high doses of grapefruit juice might enhance the effects of oral methylprednisolone.


In the above article, enhancing the effects of methylprednisolone may not be dersirable as it could lead to oversuppression of the immune system. Concerning statins, there apparently is an increased risk for statin-induced rhabdomyolysis, i.e., break down of muscle tissue. This releases myoglobin into the bloodstream which is toxic to the kidneys and can lead to kidney failure.

    Statin-associated rhabdomyolysis triggered by grapefruit consumption.
    Neurology. 2004 Feb 24;62(4):670.

    Pharmacological comparison of the statins.
    Arzneimittelforschung. 2003;53(9):605-11

    Cytochrome P450 drug interactions within the HMG-CoA reductase inhibitor class: are they clinically relevant?
    Drug Saf. 2003;26(1):13-21.

    Effects of regular consumption of grapefruit juice on the pharmacokinetics of simvastatin.
    Br J Clin Pharmacol. 2004 Jul;58(1):56-60.
    RESULTS: Grapefruit juice increased the area under the plasma concentration-time curves from 0 to 24 h [AUC(0-24)] of simvastatin 3.6-fold (range 1.8-6.0-fold; P < 0.01) and that of simvastatin acid 3.3-fold (range 2.1-5.6-fold; P < 0.01), respectively. The peak concentrations (C(max)) of simvastatin and simvastatin acid were increased 3.9-fold (range 2.3-9.3-fold; P < 0.01) and 4.3-fold (range 2.7-7.9-fold; P < 0.01) by grapefruit juice. CONCLUSIONS: Even one glass of grapefruit juice, taken daily, considerably increases the plasma concentrations of simvastatin and simvastatin acid. Grapefruit juice may increase both the cholesterol-lowering effect and the risk of adverse effects of simvastatin.

NHE
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Postby ljm » Tue Mar 14, 2006 2:43 pm

CureorBust/NHE, thank you both for your responses.
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Postby carolew » Wed Mar 15, 2006 1:26 pm

For Balsaboy: no one knows what dose to use here in MS. What I did was increase the dose of my Lipitor when I would have a slow phase, meaning, when my symptoms seemed to increase again. I eventually got up to 60 mg then 80mg but came back down to 60 mg to be able to increase the dose again, should there be a need to do so. I check my liver enzymes once in a while. Good luck. Carole[/quote]
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Postby carolew » Wed Mar 15, 2006 1:33 pm

About the grapefruit juice: one can probably take a glass of it in the morning and take their Lipitor at night. Just don't take them together. Carole :wink:
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Postby CureOrBust » Sat Mar 18, 2006 4:28 pm

I have switched from 80mg Simvastatin to 40mg Lipitor (astrovastatin) about 5 days ago.

I have pretty definitely noticed a difference. I personally think the lipitor is better for my MS than Simvastatin. The tingling in my feet has definitely improved, but my balance may be the same.

I would reccomend anyone on simvastatin to look into seeing if it makes a difference for yourself also.

I have started on 40mg for 2 main reasons:
1. I am on abx's also, and am just finishing a flagyl pulse
2. My father had liver issues on lipitor

I will give 80mg a go in a few days when the flagyl has cleared out of my system.
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Postby CureOrBust » Thu Mar 23, 2006 5:14 am

The last three days, i think i have noticed that within 1-3hrs after taking 80mg lipitor, the tingling in my feet noticeably reduces.

It gets slowly worse again during the next day, so tonight i took 40mg, and tomorrow morning i will take another 40mg. I did some searching and found that it has a half life of 14hrs (in your blood). I am hoping this method will give me a better overall result. I'll let you know how it goes.

another interesting post (and link) on this site appeared to imply that simvastatin had some effects against the EBV virus, which is sometimes alluded to for MS.
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Postby bromley » Thu Mar 23, 2006 5:28 am

Glad to hear the Lipitor is working. I saw my neuro on Wednesday and asked about statins to add to my Rebif. All he could say was that they can cause muscle problems!

As usual he used the rubber hammer to test my reflexes and a cocktail stick to test the feeling at the bottom of my feet. It's hard to believe its the 21st Century!


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Difference in Statins

Postby sunnydelilah » Thu Mar 23, 2006 2:12 pm

I started with Lovastatin and then moved on to Zocor. Lipitor is the most potent from what my doctor prescibed. I don't plan to switch as I am having good results with Zocor.
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Difference in Statins

Postby sunnydelilah » Thu Mar 23, 2006 2:18 pm

I have taken them over a period of three and half years. For me, they worked miracles as a lot of my MS paralysis disappeared. I do not even have the nerve spasms anymore. I hope you all have equal results.
Good Luck!
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Postby CureOrBust » Fri Mar 24, 2006 1:26 am

bromley wrote:All he could say was that they can cause muscle problems

He is right, and from what i have read, its irreversible. But to me, brain damage is a little more frightening. I also read that the muscle problems are rare, and cause a darkening of your urine. He can measure your CK (or something) in your blood to look for the muscle damage anyway.

bromley wrote:As usual he used the rubber hammer to test my reflexes

My doctor uses a single finger as i am hyper-reflexive... I dream of him needing the hammer.

sunnydelilah wrote:I don't plan to switch as I am having good results with Zocor

I was doing very well on zucor, but I am doing better on lipitor. It was definitely worth a trial, and I could always switch back if it even felt only the same.
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