Last week, we revisited the uses and abuses of Ibuprofen, one of the most commonly prescribed pain relief medications around the world. It is perhaps second in usage to Paracetamol, another medication we have also discussed on this page. This week, we shall be discussing the group of medications in similar common usage around the world. In many physicians’ offices and some surgeons’ consulting rooms as well, this medicine is commonly prescribed for a range of problems that have to do with high cholesterol levels. In this connection, millions of people are using these medicines regularly, and while most users will experience no side effects, many others regularly experience some difficulties as well in the domain of side effects. There are low-cost versions of the medicines available made by notable generic drug manufacturers in a number of locations around the world. In poor nations like Nigeria, these generic versions of various drugs and especially statins are the mainstay of treatment for some of the patients who struggle to keep their cholesterol levels down. For many of the people who need these drugs in our country, it becomes the duty of your physician or surgeon to determine which of them you should take in order to keep your health in check. They are, therefore, considered important medications to use in conjunction with blood pressure medications and also with diabetes drugs.
Generally speaking, statins are also known as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG CoA reductase inhibitors), which means that they prevent certain steps in the formation of mevalonic acid, thereby preventing the synthesis of cholesterol. By so doing, they can help to control the rise of cholesterol in the blood. Statins are, therefore, tablets or capsules that are usually taken once a day and depending on the type, you may be advised to take yours at certain times of the day or if you need to take them with food. Sometimes, statins are combined with other medicines in the same pill and used for a variety of conditions. In this way, Simvastatin may be combined with Niacin or Ezetimibe and help to prevent heart attack or stroke caused by occluded blood vessels; or Atorvastatin is combined either with Ezetimibe or Amlodipine to treat similar problems as noted above, or Lovastatin is combined with Niacin for essentially the same medical problems. These combinations are sometimes required when it becomes necessary to combine medications and diet to reduce high cholesterol levels and simultaneously prevent medical complications that could cause a heart attack or stroke. Statins work to reduce the level of low-density lipoproteins (LDL) in the blood. They are also called bad cholesterol and may simultaneously act to increase the good cholesterol also known as high-density lipoproteins (HDL).
While this HDL is considered to be good because it brings cholesterol to the liver from where it is taken out of the body, the LDL is considered to be bad because it builds up within the blood vessels and causes them to become narrow. There are different types of statins and we shall briefly share their names here. We have Atorvastatin, available as Lipitor, which has been in circulation for a long time and also stays in the body for a long duration. It is considered to be more potent than Simvastatin, marketed as Zocor, and also has fewer side effects. Simvastatin is also much less expensive than the former. Besides, there are Fluvastatin marketed as Lescol but now withdrawn from the market due to its severe adverse effects, Lovastatin sold as Mevacor, Pitavastatin sold as Zypitamag, Pravastatin marketed as Pravachol and Rosuvastatin sold as Crestor. These medications range in strength from 10mg to 80mg with each prescription depending on the severity of the symptoms and the tolerance exhibited by each individual patient to the different medications. As a result of these constraints, there is broad agreement about which patients ultimately qualify for the use of this group of medications.
Some of these indications are clearly noted herewith. Any person who has previously suffered from a stroke or has had a heart attack becomes eligible for the use of these medications because of the risk of a second episode. The same thing can be said for the person who suffers from peripheral vascular disease. The second group of patients for consideration for the use of these medications are people with diabetes and LDL of at least 70mg/deciliter and between 40 and 75 years of age. It is particularly important in these patients if they have suffered from diabetes for more than five years. The third group of beneficiaries of this consideration are those who belong to the immediate last group and are considered to be at risk for getting heart disease.
Lastly are those people who have a persistently high low-density cholesterol level of above 190 mg/deciliter for whom exercise and dietary changes have been unable to improve their numbers. In a more general way, and as a precaution, these medications are often prescribed together with antihypertensive medicines or diabetic drugs when patients already have these systemic disease conditions. It is called precautionary because in a good number of situations, no laboratory results are available to determine the cholesterol profile of these patients. Where the facilities are available, it is important to determine the lipid profile of the patient before the prescription is considered.
Statins are not without their own problems when used for any length of time. As stated in the first paragraph, most of the side effects are mild. These include such problems as headaches, diarrhoea and excessive production of gas. Nausea, dizziness and severe muscle aches can also develop. There could also be joint pains and constipation. These medications should not be taken during pregnancy and while breastfeeding. If you are pre-diabetic, the use of statins can push you over into full-blown type 2 diabetes and your doctors will need to be informed about this fact at the point of prescribing the medicines. It is just as important if a patient has liver disease. The severe symptoms associated with the use of these drugs include memory loss, kidney and liver damage, and confusion. In the same way, muscle problems already noted among the mild side effects can worsen and over time, type 2 diabetes and even erectile dysfunction can become further complications. Like many other medicines, if one type gives you certain unpleasant complications, you must have a conversation with your doctors to determine if a switch can be made to another member of the class of drugs. It is also a factor that these medications can interact with other medicines of another class to cause side effects or worsen the ones already developing. The intake of alcohol can make side effects worse. So also can grapefruits or the juice made from grapefruits.
The issue of statins and their side effects is gaining increasing prominence among our urban populace because that is where the incidence of both hypertension and diabetes are also highest. The other members of the quartet of disease conditions that make cholesterol levels rise are obesity and cigarette smoking. These health problems increasingly associated with urbanisation will become a huge disease burden among non-communicable diseases in a few short decades, perhaps within a generation.
Questions and answers
Dear doctor, recently I watched a video where it was stated that if cold water did not affect you during your younger days, it would harm you in old age. It was said to be able to close four veins in the heart and cause heart attacks. It affects other internal organs, they said such as the liver and it was said to be the most common reason for making many people require liver transplantation. Also, the video claimed that cold water adversely affects the internal walls of the stomach and large intestine and leads to cancer. Please how true are all these claims? It was a stark warning to those of us who take cold drinks and iced water. I have taken these items for many years and have never known anything different from the fact that it is safe to drink cold water for example. 0803304****
I believe that this is a fantastic tale told by ignoramuses essentially peddling their version of illiteracy; there is no truth in it. When people anywhere feel really hot as per the prevailing weather conditions, they seek refuge in drinking cold water and drinks. No one has developed some kind of adverse health condition from that or died as a result. On the other hand, when people feel really cold, they seek warmth by drinking hot beverages. This is simply nature at work.
Dear doctor, thank you for the tremendous amount of work you are doing for us. Please is it a sign of good living or an ailment to fart excessively like 10 times a day? I am a man of 72 years old. 080338****
Thank you, sir, for your kind words of encouragement. We have had cause in the past to discuss the mechanism of the formation of gas within the gastrointestinal system and concluded that it was a normal occurrence. The average person will fart about 14 to 23 times a day and most of the time, it will not even smell. Occasionally, there is a smell which is dependent on what you eat. So, doing this only 10 times a day is neither excessive nor a symptom of any disease condition. When you are not able to fart, it signifies plenty of trouble.
Dear doctor, around 2018, I strained my neck while exercising. I later saw a GP (General Practitioner) who prescribed Arthrotec 75 for me to use. Later on, I went to LASUTH (Lagos University Teaching Hospital), Ikeja. I was told to do an X-ray; the orthopaedic surgeon studied that X-ray and decided that I would need a neck brace but he still prescribed Arthrotec 75 but said I should come for the brace. I continued to use Arthrotec till now, but the pain is getting worse. Because of the crowd at LASUTH, I decided to go to Igbobi (National Orthopedic Hospital). My thought was that the new consultation would be to advise that a brace should be put on my neck at this time but I saw a doctor undergoing residency and he prescribed a medication that will only last two weeks and gave me a date to see probably an orthopaedic surgeon in four months’ time. I am surprised that he did not decide to recommend a brace for the neck but only prescribed drugs to last two weeks. The pain is now back; please is Igbobi Hospital worth going to if you are an outpatient? 08133****
Your question assumes a number of things; the first assumption is that because the doctor at LASUTH asked you to wear a neck brace (likely a cervical collar), the one you saw at Igbobi must similarly ask you to do the same. Secondly, this problem you have has been on now for five years and is no longer considered an urgent case. In the final analysis, the most important thing you need to know is that both hospitals are good and the doctor you saw at LASUTH likely trained at Igbobi as a specialist. Lastly, it is unlikely that X-rays alone can determine the problems you have in your neck and you will need to use your recent prescription for the two weeks as recommended while wearing your cervical collar for the time being. You should also realise that after five years of using Arthrotec, not many doctors would want to place you on more pain-relieving medicines for any significant additional length of time. So, Igbobi is worth going to as an outpatient and as somebody with a chronic condition, you should patiently await your appointment. However, if at any point before then the pain becomes unbearable, you ought to report to the casualty department and you will be attended to.
Dear doctor, I am the person who complained about six weeks ago about the pains I was having in my right hand and leg and eventually moved over to the left side after a really long time. I was on Cocodamol, Naproxen, Dihydrocodeine, Dolometa-B and Cataflam for almost three months with physiotherapy without any significant improvement. Well, you advised me to see a neurologist. I saw him two weeks ago and he recommended I do an MRI of the neck. The report says all the cervical vertebrae are dehydrated. There are osteophytes seen on the end plates of C4-C6. At C3-C4, there is disc herniation with the herniation impinging on the cord. There is anterior thecal space narrowing. The exit foramina are narrowed on the left side. The same thing is reported for C6-C7. He has referred me to a neurosurgeon for an operation. What do you advise? I have a health challenge already being that I am diabetic. 080943****
Well, you should ideally see a spine surgeon but if you are not able to see one around where you live, meaning your state of residence, a neurosurgeon can still help you a great deal. An operation is required, as you have been advised, to decompress those segments of the cervical spine where your spinal cord is being placed under direct pressure. Without doing so, the condition will progress and paralysis could eventually result. Lastly, with regards to your diabetic state, that can be controlled adequately prior to the operation and maintained during the operation. In the typical Nigerian public hospital, you will be given a prescription to obtain your glucometer and the relevant test strips.
Dear doctor, my sister-in-law, aged 41 years, died recently because she had fibroids and an abnormal heartbeat. Because of this heart problem, the surgery was constantly postponed until she decided to start going to a different hospital, where she was told the doctor could do the operation even with the irregular heartbeat. Then suddenly, about eight days ago, they just called us to say she was dead. I was with her the previous week and she complained to me then how much bleeding she was experiencing due to the fibroid and how she was afraid of doing the operation because of the fear the various doctors she saw had put in her mind. What should we have done to avoid this? 070164****
Well, it is sad that she passed away at such a young age. When you say that the heartbeat was irregular, it is not clear what you mean. Was it slow but irregular or fast and irregular? There are differences between these and their causes are as different as night and day. So also is their treatment. If she bled so heavily during her last period, that might have tipped her into heart failure. On the other hand, either of the two heart conditions could have caused her sudden death. The key there to having a safe operation would have been to get a cardiologist and a haematologist to manage her condition, stabilise her and make her fit enough for the required operation. This would have meant going to a teaching hospital or a federal medical centre depending on where you both live where all these experts are based and can work together. To have been going from one private hospital to another was not a solution to the problem.
Dear doctor, thank you for educating the Nigerian populace in the Sunday PUNCH. May God reward you for the good work you are doing. About two months ago, my husband discovered some rashes on my right buttocks and I started by applying Tribotan cream to the area. I used to apply it at night when I want to go to bed. But it has refused to go and it is actually getting bigger. The itching is terrible and when I scratch it, I sometimes injure myself. What should I do about this and how can I cure the one inside my body? 080265****
Thank you very much for your prayers. The cream you have been using has not been properly applied; you ought to have been applying it two times a day. However, it is spreading by your account which is an indication that you are probably treating the ailment based on a faulty diagnosis. That means you have not seen a doctor for examination. You should do that. Confirm whether it is a fungal infection or some other lesion and get the treatment that is appropriate for it. This is unlikely to have any component within your body because all this while it has been limited to your right buttock. There is no need to look for tablets or capsules to swallow.
