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I have seen a patient with such significantly high trigs that did respond so quickly to fibrate, and remained low once treated. So, whilst there is a link with venlafaxine I would leave on the fibrate. After all, the link with venlafaxine is not necessarily truly due to the drug but could be due to alcohol consumption in mental health problems. TIM ************************************************************** Prof. Tim Reynolds Consultant Chemical Pathologist / Associate Clinical Director - Diagnostics / R&D Lead Burton Hospitals NHS Foundation Trust Work Tel: 01283 511511 extension 4035 Work Fax: 01283 593064 Mobile: 07973 278767 WORK: [log in to unmask] <mailto:[log in to unmask]> HOME: [log in to unmask] <mailto:[log in to unmask]> Queens Hospital, Belvedere Road. Burton On Trent, Staffordshire. DE13 0RB This e-mail, and any files transmitted with it, are confidential and intended solely for the use of the individual to whom it is addressed. If you are not the intended recipient please destroy this message, delete any copies held on your systems, and notify the sender immediately. You should not retain copy or use this e-mail for any purpose, nor disclose all or any part of its content to any other person. If you have received this e-mail in error, please notify me on 01283 566333 Ext 2126 P Please consider the environment before printing this e-mail ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mohammad Al-Jubouri Sent: 21 September 2012 3:41 PM To: [log in to unmask] Subject: Re: Friday afternoon challenge Hi Danielle, You probably would agree that neither simvastatin nor ciprofibrate has produced the reduction in TG levels in this patient. There are few case reports linking Venlafaxine to the development of severe hypertriglyceridaemia, so worth withdrawing this drug. Regards Mohammad Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath Consultant Chemical Pathologist From: Freedman Danielle (RC9) Luton & Dunstable Hospital TR <[log in to unmask]> To: [log in to unmask] Sent: Friday, September 21, 2012 3:18 PM Subject: Friday afternoon challenge Any ideas please ?? I think I must be missing something.... I saw a new patient in clinic yesterday with a very odd series of lipid results 54 yr old Caucasian female( not from Luton, but Harpenden) non smoker, type 2 DM ( HbA1c never high according to GP), BMI 35, minimal alcohol consumption No clinical stigmata of hyperlipidaemia Drug History Metformin Amlodipine Candesartan, Venlafaxine Femoston Inhalers for asthma No other real PMH June 2011 Tg 45.0, Chol 8.4 mmol/L Gp started her on Simvastatin 40mg !! July 2011 Tg 5.2 , Chol 4.1 mmol/L No bloods for 12 months 21/8/12 Tg 29.6, Chol 15.2 HBA1c 51mmol/mol 30/8/12 Tg 93.0, Chol 20.4mmol/L All above samples assayed at another lab using Vitros and GP lab reports say samples were lipaemic She was still on Simvastatin 40mg Gp phoned me on 13th Sept and I told her to stop Statin and give her Ciprofibrate 100mg nocte,( so had been taking it for 1 week) and saw her yesterday Her fasting lipids today on Beckman Tg 4.4, Chol 4.0, HDL 1.84 mmol/L FBC ( and MCV),LFT and U and E normal Patient denies any excessive indulgence in fatty foods. Any ideas why this patient had 3 out of 4 such deranged results...? My colleague suggested we give her a " Pizza and chips challenge"..... Many thanks Regards Danielle Dr Danielle B. Freedman MB BS, FRCPath,EurClinChem Divisional Director Diagnostics, Therapeutics and Outpatients Luton and Dunstable University Hospital NHS FT Luton, LU4 0DZ +441582 497212 ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk/ Green Laboratories Work http://www.laboratorymedicine.nhs.uk/ List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/