The other thing to consider in this situation is microsomal induction of
simvastatin to less active metabolites. I came across a case a couple of
years ago of a patient on simvastatin where the introduction of phenytoin
led to a dramatic rise in the total cholesterol (Postgrad Med J
1999;75:359-60). Gamma GT acted as a marker of the microsomal induction.
Pravastatin is the only statin which is not metabolised by this enzyme
system.
-----Original Message-----
From: William Marshall [mailto:[log in to unmask]]
Sent: 25 February 2002 14:49
To: [log in to unmask]
Subject: Re: Statin Resitance
Most patients on statins do not have a raised CK. I had thought that this
was an idiosyncratic, rather than a dose-related, effect.
If compliance is not an issue, I am sure that he will have been screened
for hypothyroidism. Some patients respond poorly to statins - I have
wondered whether this is related to their intestinal cholesterol absorption
- and it would certainly be worth his clinician prescribing him a bile acid
sequestrant.
William M
At 12:27 25/02/2002 +0000, GARETH DAVIES wrote:
>Dear All,
>
>We have been discussing a young (my age - upper 40s) patient with a
>cholesterol greater than 10mmol/l who is prescribed 80mg simvastatin but
his
>cholesterol is not falling by the expected amount. We will be seeing him to
>ascertain whether he is compliant but a question that was raised concerns
>"resistance" to a statin formulation.
>
>At 80mg, we would expect a raised total CK. The question is: does the
>magnitude of a rasied CK correlate with the magnitude of the effect of the
>treatment on cholesterol levels? ie, is a higher CK associated with a
>diminished cholesterol-lowering effect
>
>I've had a look at PubMed but its difficult to phrase the search
adequately.
>Has anyone come accross any published studies?
>
>Many thanks.
>
>Gareth
>
>Gareth Davies
>Senior Clinical Biochemist
>Wrexham Maelor Hospital
>Wrexham LL13 7TD
>UK
>01978 725345
>
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From: Dr William J Marshall
Reader and Hon Consultant in Clinical Biochemistry
GKT School of Medicine
London SE5 9PJ
UK
telephone: 020 7346 3275
facsimile: 020 7737 7434
email: [log in to unmask]
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