[Dr.Vad]

Уважаемые коллеги,

Вариант назначения статиновой терапии при развитии поб. эффектов:

Statins are normally administered for the treatment of dyslipidemia on a daily basis. This standard dosing regimen is well tolerated by most patients. Occasionally, patients discontinue therapy secondary to side effects, most commonly myalgias. We describe 2 patients who were unable to tolerate daily atorvastatin therapy secondary to myalgias and were subsequently treated with rosuvastatin administered on Mondays, Wednesdays, and Fridays, with resolution of adverse effects. Significant reductions in serum low-density lipoprotein cholesterol levels were observed in the 2 patients despite the alternate-day dosing regimen. Rosuvastatin was chosen because of its long half-life (19 hours) and very high potency.

We describe 2 cases of women with goal low-density lipoprotein cholesterol levels of <130 mg/dl and 10-year Framingham risks of 15% and 5%, respectively, who were previously intolerant to atorvastatin therapy and were switched to rosuvastatin administered on Mondays, Wednesdays, and Fridays at 2.5 and 5 mg, respectively.

Изменения липидных показателей в обоих случаях соответственно к 6 неделе по сравнению с исходными данными
Total cholesterol −29% −14%

LDL cholesterol −38% −20%

HDL cholesterol +23% −9%

Triglycerides −27% +19%

Alternate-day dosing of statins may have a role in lipid-lowering therapy in select patients. Our case reports illustrate that Monday, Wednesday, and Friday dosing of rosuvastatin may provide an effective reduction in serum low-density lipoprotein cholesterol while avoiding the previously encountered side effects, specifically myalgias, with daily statin therapy. It is unclear if the absence of myalgias was secondary to a change in the specific statin, the decreased frequency of dosing, a potential placebo effect, or a combination of these. The potential benefits of this dosing regimen include a decreased incidence of adverse effects, decreased costs to patients and the health care system, and increased patient compliance.

Из Am J Cardiol. 2007 Jan 15;99(2):291.
Monday, wednesday, and friday dosing of rosuvastatin in patients previously intolerant to statin therapy.
Mackie BD и соавт.

[muravei]

Уважаемый доктор! А если больная с бронхиальной астмой и ИБС(холестерин более 9,) не переносит все группы статинов и это проявляется в виде афтозного стоматита? Что назначить?

[Dr.Vad]

можно фибраты, можно эзетимиб, если есть и повышенные триглицериды, то можно попробовать и полиненасыщенные жирные кислоты (омега-3)

[muravei]

Извинате за молчание. проблемы с интернетом. Я дала ей омега-з, честно говоря с фибратами не работала. а какова эффективность омега-з кислот? недавно читала в журнале хвалебгые отзывы о препарате на онове этих кислот.

[muravei]

Прочитала про исследования эффективности сочетания статинов и эзетимиба, а есть ли смысл сочетать его с омега-3 ?

[Dr.Vad]

Статины и омега-3 примерно одинаково снижают риск сердечно-сосудистых заболеваний, по крайней мере согласно недавнему мета-анализу (Arch Intern Med. 2005 Apr 11;165(7):725-30)
Добавление омега-3 к статинам еще на 20% снижало риск СС заболеваний (трайл Japan EPA Lipid Intervention Study) в нижеприведенной публикации стр.274-5:

[Ссылки могут видеть только зарегистрированные и активированные пользователи]

[muravei]

Уважаемый Dr.Vad, спасибо за отклики.

[Dr.Vad]

(Am J Cardiol. 2007 Aug 1;100(3):554-555)

Overall, statins are well tolerated by most patients, with a low incidence of adverse effects. Discontinuation rates with statins from early clinical trials were <4%.1 In practice, however, the rates appear to be higher. Previously, we reported efficacy and better tolerability in patients with previous statin intolerance when the agents are dosed every other day. Nevertheless, 40% were still unable to tolerate the alternative dosing.2 We describe herein 8 patients previously intolerant to standard once-daily statin dosing who were placed on rosuvastatin once weekly. To our knowledge, this is the first report indicating efficacy and improved tolerability when using rosuvastatin once weekly.

Case Descriptions

The 8 patients described were referred to a lipid-specialty clinic for inability to tolerate traditional once-daily statin dosing. Most had previous intolerance of myalgias without elevated creatinine phosphokinase levels, 1 had a history of markedly elevated liver function tests (>3 times the upper limit of normal), and 2 had gastrointestinal complaints. Patients were prescribed once-weekly rosuvastatin (range 5 to 20 mg) and were followed for an average of 4 months. Overall, this patient population experienced a mean low-density lipoprotein (LDL) cholesterol reduction of 29%. Patients were excluded from the analysis if other changes were made that would have affected their lipid profiles. A total of 10 patients were prescribed the once-weekly rosuvastatin regimen, but 2 patients reported the same side effects as originally experienced with once-daily statin dosing and subsequently discontinued therapy.

Comments

When patients who require marked LDL cholesterol reduction present with previous statin intolerance, it often poses a major challenge for practitioners. Once-weekly rosuvastatin in this patient population provides significant cost savings and potentially helps achieve the 30% to 40% LDL cholesterol reduction suggested for high-risk patients by the Adult Treatment Panel III update.3 Possible explanations for the patients’ tolerating the once-weekly regimen may include lower overall plasma concentrations from the less frequent dosing, switching to a different statin, or the psychologic factor of receiving only a once-weekly dose. The substantial reduction in LDL cholesterol is not fully elucidated, although 2 factors that may partially clarify our results include the high potency and relatively long half-life (19 hours) of rosuvastatin. Approved doses (5 to 40 mg/day) of rosuvastatin significantly reduce LDL cholesterol by 45% to 63%,4 but doses as low as 1 mg/day have also provided significant LDL cholesterol reductions up to 34%.5