Prescription med question--need advice by Friday doc app't.

[blondeatlast]

I've already talked to my PC doc and my favorite pharmacist on this, but I'm trying to get as much info as possible.

I've recently been switched from Zocor to Crestor.

Two big problems: Crestor isn't covered by mine, or any insurance company. Very disturbing, IMHO, and unaffordable.

Problem 2 is that I am reading some very disturbing info on both the effectiveness and safety of Crestor. Some of this comes from Public Citizen's "Worst Pills, Best Pills" site, which is a subscription site that is so concerned about the issue that they are offering the info free to all. (I'm not a subscriber, but may become one).

I DON'T want to be on this stuff; can anyone help me talk to my usually very good PC doc? I'm afraid she's being swayed by the "Free Lunches" offered by the drug reps--she doesn't want to take me off of it.

I have a Friday appointment with her. Please keep this kicked up til then.

[oneighty]

1. Why

Were you taken off Zocor? Wife and I both take Zocor. No side effects we are aware of.

180

[blondeatlast]

2. I don't seem to be responding to it.

I'm on the max dose and eat pretty well. I DO have insulin dependent diabetes, which complicates things immeasurably.

That's one reason I'm concerned about the Crestor; it is said to cause more kidney and liver damage than any of the other statins.

[dmr]

4. If you are not responding to a drug that your insurance will pay for

and the next drug of choice is not a part of your insurance formulary, your doctor should be able to contact your insurance company and request a non-forumlary drug approval.

I'm not familar with Crestor, and can't comment on it, but ask your doctor and then ask your pharmacist whether its benfits outweigh the risks. You might even ask your pharmacist do a consult with your physician to help find the right medication or combination of medications to keep you healthy.

[dmr]

3. Explain to your physician

that Crestor isn't available on your insurance formulary, but they will pay for Zocor. Most doctors are sympathetic and will prescribe accordingly.

BTW, what did your pharmacist say?

[blondeatlast]

5. She wasn't aware of a problem, but sghe was going to look into it.

Here's the wierd part: When my doc prescribed it, she casually mentioned that she knew it wouldn't be covered yet. I told her then that I would like to remain on the Zocor, but she kept to it anyway.

She's been my primary care (I have many specs, too) for years, and have never felt uncomfortable. But I'm smelling a rat here, in the form of a drug rep free lunch. I had virtually the same conversation with my cardiologist, and they gave me bunches of samples, but insisted I use the Crestor.

Maybe I'm paranoid, but this is really bugging me.

[Ilsa]

6. Perhaps retesting after using the samples

will show whether it is effective for you. With that solid information, perhaps your insurance can be persuaded to give you coverage.

I don't know anything about comparing the adverse effects from the drugs.

I find it odd that your doc didn't want to listen to your concerns after all these years.

[blondeatlast]

7. Yeah, I've always liked and trusted her (I call her my whole Laurel doc)

The Cardio I can kind of understand, just a couple of years.

[dmr]

9. I see what you mean, and don't blame you

it's hard to say, because she and your cardiologist may honestly believe you will benefit from Crestor or the doctor(s) may have stock invested in Crestor.

I'm retired after 26 years as a healthcare professional (pharmacy). If your doctor understands you will not be compliant, she will either prescribe zocor or get that non-formulary drug approval from your insurance company for crestor - only the physician can do this, as they have to justify the whys and whatfors.

Go to this site http://www.crestor.com/p/ and click on Prescribing Information for healthcare professionals (left hand side of page), it'll take you to a pdf file. I think some of your concerns regarding the renals and liver may be allayed by reading this. If you currently do not have liver issues or not predisposed to myopathy, the doctors most likely believe the benefits outweigh any of the risks.

Liver Enzymes
HMG-CoA reductase inhibitors, like some other lipid-lowering therapies, have been associated with biochemical abnormalities of liver function. The incidence of persistent elevations (>3 times the upper limit of normal occurring on 2 or more consecutive occasions) in serum transaminases in fixed dose studies was 0.4, 0, 0, and 0.1% in patients who received rosuvastatin 5, 10, 20, and 40 mg, respectively. In most cases, the elevations were transient and resolved or improved on continued therapy or after a brief interruption in therapy. There were two cases of jaundice, for which a relationship to rosuvastatin therapy could not be determined, which resolved after discontinuation of therapy. There were no cases of liver failure or irreversible liver disease in these trials.

It is recommended that liver function tests be performed before and at 12 weeks following both the initiation of therapy and any elevation of dose, and periodically (e.g., semiannually) thereafter. Liver enzyme changes generally occur in the first 3 months of treatment with rosuvastatin. Patients who develop increased transaminase levels should be monitored until the abnormalities have resolved.

[blondeatlast]

11. Ahhhh, thanks. That's the kind of info I needed.

I do need to get the CHO down and the Zocor just doesn't seem to be working. I'm not normally an alarmist.

I now feel I can have a reasonable talk with her about the problem, and if she thinks I should stay on the Crestor, I will. I have to weigh the risks and benefits--the high CHO isn't doing any good for me, either.

I have this deep, dark, mistrust of pharmaceutical companies, which is strange, since I am so at the mercy of them (insulin dependent, pre-menopausal heart disease, etc). And yet my sister is a pharmacist in a hospital (on second thought, that may be the reason; she is no fan of drug reps and tries to warn the residents not to be taken in by them).

[dmr]

13. That mistrust is warranted

my work was in a 1600 bed teaching hospital (except for part-time temping in prisons, health department, and even temped for Humana!). Drug reps were allowed to visit only the pharmacy storeroom or pharmacy administrative offices; but they are sneaky shits, and would find ways to circumvent hospital policies and state laws. We were very strict, and if we found proof (which was one of my responsibilities), they would receive a letter of reprimand to their home office, if there was a second violation, they would be banned, which effectivly dampened their career quite a bit. We could always tell when a drug rep was touting their new drugs, as it was reflected in the patient's med orders. We had a near iron-clad formulary, whereby the physician would have to justify a non-formulary medication, and in the case of residents, their Attending Physician had to sign off on it before submitting it to us and the Pharmacy and Therapeutics (P&T) Committee. I cannot tell you how many times I had to confiscate sample medication. The tricks they pull, and the doctors who fall for it would curl your hair. It's a dangerous game they play.

While I'm sitting here writing this, I remember sitting in on a inservice with the rep as he spoke to the docs on how safe Oycontin was and how it was nearly impossible for a patient to become addicted to it. I think about that meeting a lot lately. < sigh >

Good luck Friday.
:)

[blondeatlast]

8. Kicking--hoping for some professional advice as well.

[BiggJawn]

10. "TELL your Doctor" Screw "asking"...

Tell your doctor that you don't get paid enough to take off-formulary drugs... If she insists on keeping you on Crestor, say "Look...what part of 'I can't afford this and I'm NOT gonna buy it instead of food' did you NOT understand?"

I hear ya about the "Drug Rep Free Lunch". Shame that our well-being can be bought and sold so cheaply, isn't it?

after about 2 years of arguing with my PCP about the pills he was putting me on ("If this one isn't working, WHY do i have to keep taking it? It's expensive." "Hmmmmm....Because there's a benefit...")I gave up. After his crack about "Hmmmm...Putting on some weight, arent we?" and after that I found out TWO of the pills I'm on "May cause moderate weight gain..."
AND....He had me on Thiazide after assuring me it didn't cause impotence (which resulted in a less-than-stellar summer vacation)I quit him.
I found a new PCP. Hope I don't have to change this one. I have 4 pages of "interview" questions for her on my first appt....

[cosmicdot]

12. I checked the price at a Canadian outlet ...

this came up at http://www.tcds.com
Canadian drug store

Crestor 10 90 $149.98
Crestor 20 90 $179.97
Crestor 40 90 $199.97

[Bossy Monkey]

14. Try here

It's basically all the stuff that's in the Physician's Desk Reference:
http://www.rxlist.com/cgi/generic/crestor_wcp.htm
As I read it, Crestor is to be approached with caution with patients having renal impairment. Depending how far your diabetes has advanced, that might be you.
Also click on the second horizontal blue bar for side effects/drug interactions, and other very useful information, including results from clinical trials.

Zocor is the one that is getting advertised into the ground; my shrewd guess would be that if pharmaceutical company reps are pushing something on doctors aggressively, it would be this.