Talk:Atorvastatin/Archive 1

WikiProject Drugs guidelines
I'll be working on this for a while, trying to get it to conform to the WikiProject Drugs guidelines. Please review these guidelines before extensive editing. Starbane 03:01, 27 Oct 2004 (UTC)
 * I take Lipitor. Perhaps the article could mention (and/or refute) the side effect of muscle-wasting, the recommendation that it be taken at around 8PM for maximum effect, and the recommendation that grapefruit be avoided.

Take a look at Acetaminophen to see where this is eventually going.Starbane 18:56, 27 Oct 2004 (UTC)

Here are some of the topics I want to add to this article, along with a more comprehensive introduction. (Yes, I did steal these topics off another page.)

Etymology History Available forms Mechanism of action Metabolism Toxicity References External links Related topics

Starbane 18:55, 27 Oct 2004 (UTC)

Also, I'll put a Chemical Data area.

Is there some way to get the Lipitor logo to appear above the sidebar of information, rather than to the right of it? --KoopaTroopa211 20:57, 14 August 2005 (UTC)


 * Starbane, thank you for the article. When you get a chance to work on this article again, do consider adding the date the patent of this drug was issued preferably under the "history" section of the article

Are Statin Drugs Worth Taking
Statin drugs are very powerful medications, and there are many reported serious side effects associated with them. If your physician suggests that you begin treatment with them, one should carefully discuss the issue with the doctor and also do extensive research on the Web or related materials to understand all the issues involved and risks of side effects before starting statin therapy. The NIH (National Institute of Health) has done extensive research and has excellent Web sites to cover a variety of subjects and issues. Specifically, with respect to cholesterol correlations and heart disease, the following website is interesting (www.nhlbi.nih.gov/about/framingham/riskabs.htm ).

Cholesterol is a very vague word and is used to describe a spectrum of long chain hydrocarbons (lipids), that are used by the body for the health of the cellular structure. The profile of total cholesterol, and its division into HDL (high density lipoproteins), LDL (low density lipoproteins) and finally triglycerides, is a very important factor, and is unique for each individual. Thus taking a medication that significantly reduces these levels, can lead to serious side effects. The major side effects that are reported on various Web sites are muscular pain, fatigue, peripherial nerve effects, and arthritis. In many cases, the side effects are non-reversible. Given that fact, one should really ask the question:  "Are Statin Drugs Worth Taking"--Jtclemens 20:47, 16 December 2005 (UTC)


 * Statin drugs are worth taking in patients at risk for cardiovascular disease. This is borne out again and again by large trials. If the side-effects are poorly tolerated other drugs or doses may be necessary. Don't rely on websites - the package insert is your best friend (the websites cannot be sued for erroneous information, the drug company can!) Indeed the lipid profile is important - if the high total cholesterol of 5.5 is caused by an HDL of 3.0 then there may be room to argue. But the Heart Protection Study strongly suggests that even patients with normal cholesterol levels may benefit from statin treatment if they have risk factors for cardiovascular disease. JFW | T@lk  12:49, 18 December 2005 (UTC)

To determine whether a patient is at risk for cardiovascular disease, then one must have a set of guidelines, that have been peer reviewed and generally agreed to by the medical community. The website that I list above is an official website of the U. S. National Institute of Health (federal government agency) and the Heart, Blood and Lung Institute, which is part of the National Institute of Health and has been the leading agency in conducting the Framingham Study, which started the research of correlations into heart disease, diet, exercise, family history, smoking, genetics and cholesterol. To give the reader a sense of why it is important to do a lot of individual research into this question of risk factors, I will use myself as an example of why the research is important. The NIH website lists the contributing factors to heart disease and assigns risk points to each factor. When I first considered going on statin therapy (Lipitor) I was 59 years old, was not hypertensive, not overweight, did not smoke, did not have diabetes, ate a healthy diet, but my cholesterol level was averaging about 250 ( HDL = 60, LDL = 170, Tri = 100). Note that I have mentioned the triglycerides level. A subject's LDL is not measured directly, but is inferred by measuring total cholesterol level, the HDL, and triglycerides levels and then using the formula LDL = (Total Cholesterol) - HDH - ((triglyceride)/(5)) Your LDL level is calculated. My profile has been at that level, since it was first measured when I was 32 years old. I had no symptoms to suggest any heart disease, but there was so much public discussion about cholesterol and its correlation to heart disease, that my doctor suggested I start statin therapy. I did. I had all the normal blood work done and showed no adverse effects, initially. About one year later, I had the onset of malaise, sharp muscular pains in my left and right thumbs, hands and wrists. I saw my doctor immediately and statin therapy was stopped, while I was tested for many possible diseases. I saw four different physicians, an internist, two arithritis specialists and an orthopedic specialist. The symptoms were subsiding, but did not disappear completely. My final diagnosis was that I either had suffered from a parovirus B-19 infection or that I had classic osteoarithritis. The arithritis diagnosis could not explain the rapid onset of the symptoms or the symmetry of the pain in both my hands. Thus under my doctor's urging, I once again started statin therapy - Lipitor. My symptoms immediately began to reoccur and I also developed abdominal and chest pains, was fatigued, had constant indigestion and then developed a urinary tract infection (the only one I have ever had in my life). I stopped my medication and returned to my family doctor, who now agreed that I suffered from the side effects that are seen when using statins. Causality was clearly established, and a delayed onset of initial side effects was demonstrated. My doctor then prescribed Zetia, a medication that blocks the intestinal adsorption of cholesterol in one's diet. After reading about Zetia, I learned that it is not usually administered alone, but with a statin and is helpful for patients who already have heart disease. There are also side effects associated with Zetia. I declined to take the medication. I also carefully reviewed all my blood work, and I noticed that my triglyceride level had risen from a steady 100 to 150 when I had the reaction. On my last test after being off Lipitor for one year, my triglyceride level is now back to 100. One should point out that high triglyceride levels are also a cause for heart disease. A level of 150 is considered borderline high by the medical community. My cholesterol levels are back to their original values. I am still working to rebuild my stamina. I asked my doctor if he was going to report my reaction either to the manufacturer or to the FDA. His response was that if he reported all the adverse reactions to all the medications that he prescribes, he would have no time to practice medicine. Therefore, I reported my entire history to Pfizer, my telephone conversation was taped recorded and several weeks later my family physician was sent a set of forms by Pfizer to fill out concerning my health profile. They even requested the batch serial numbers for the medication I had taken. Well, I receive my medication from a major health service provider, and it includes a prescription plan. When they send you the medication in the mail, it comes in their packaging, since they buy it in bulk, at reduced cost from the manufacturer. There are no manufacturer's data sheets or serial numbers. My doctor was surprised by this, but doctors do not know where and how, or who fills their prescriptions. At this point after 18 months off the medication, I have pain reduction of about 80% but I still have definite residual pain in both hands. Chest pains, admoninal pains have disappeared, indigestion has disappeared and no urinary tract infections have reoccured. I have also had a cardiac stress test performed, an MRI cardiac stress test performed, and doppler sonograms of my neck arteries and my legs. All tests are negative. By NIH results and their data on the website that I referenced above, the risk of my developing heart disease in the next 10 years is 9%, and is based solely on my age, which is not an adjustable variable. In summary, doctors are not fully aware of all the side effects for all the medications that they are prescribing. Patients, through direct marketing via television and print, are asking to try new medications. Doctors are in overload with their work schedules. Doctors do not receive complete information from drug companies concerning adverse edffects. Drug represenetatives visit doctors routinely and give them large batches of free samples to pursue them to prescribe the medication. Drug manufacturer web sites can be very misleading, and do not report continuing information that they learn about medications. While the Web is not peer reviewed, it is a source of raw data that can be reviewed by anyone. That makes it a very valuable tool. Thousands of patients have posted their experiences with all types of medications.

In the final analysis the patient is the responsible person for their health. --Jtclemens 02:20, 19 December 2005 (UTC)


 * In the UK you would not have had a statin. In isolated hypercholesterolaemia without any other risk factor you would have failed the Framingham risk assessment available to every UK doctor. Naturally I have no explanation for your side-effects, and it's a shame you were disappointed in reporting them. At the same time, there are literally millions of people on atorvatstatin doing just right, so I reckon your problems are either a very rare idiosyncratic reaction to the drug or its excipients or due to an alternative cause. You are correct that ezetimibe is only an adjuvant to statin therapy. JFW | T@lk  20:25, 22 December 2005 (UTC)

Info
Does anyone know of a good source for drug sales figures? Preferably a source which would meet Wiki's criteria for a reputable source. Internet searches have so far led to a lot of advertising for the drugs I'm looking for. Thanks.--PharmerJoe 19:57, 28 December 2005 (UTC)


 * Perhaps the Pfizer website, or an email to their PR department as to where their annual sales are reported (e.g. in an annual financial report)? The most reliable source of sales should be the manufacturer. JFW | T@lk  20:18, 28 December 2005 (UTC)


 * I think the Drug Discovery Today article cited as ref. 1 is reputable enough: http://dx.doi.org/10.1016/S1359-6446(05)03468-9 . Itub 22:59, 28 December 2005 (UTC)

That's very good. JFW | T@lk  13:30, 29 December 2005 (UTC)

Look under the investor section and the financial and performanace coporate reports. For example, in 2004 Pfizer sold over $9,000,000,000 (9 billion) dollars of Lipitor. Here is a little interesting math calculation that one may be interested in. It sheds light on several different aspects of the statin story. Lipitor is the largest selling drug in the United States and has been challenged in recent patent lawsuits, by companies wanting to produce a generic version. Pfizer won the lawsuits. There was serious discussion in the United States Congress and media that statin therapy be moved from a prescription drug to an "over the counter" drug. If this were to happen, who would monitor adequate dose levels, regular blood tests, and how would adverse reactions be reported. After several weeks of discussion, this item disappeared from the new media. This calculation is conservative and underestimates the number of people on daily lipitor therapy. At retail price, Lipitor sells at about $3.00 per pill. That yields a yearly cost of $1,095 per patient, if they do not have a subsidized health plan. If we round that to $1,000, then there are 9 million people on Lipitor therapy, without counting any other statin drug. Another very conserative assumption, if we assume that only 1% of the lipitor patients experience significant side effects, then 90,000 patients are affected. This number is very large. No manufacturer of any product would want to admit that approximately 100,000 people are seriously affected by their medication. If they did the class action lawsuits would lead to finanical ruin. Merck, Inc. is now fighting the Vioxx litigation. New medications have had a dramatic effect in either eliminating or minimizing many diseases and their debilitating effects. But as the number of users increase, the side-effects must be addressed and measures developed to eliminate them. The metric should not be the percent experiencing serious side efects, but more importantly the total number of persons being affected. This may sound like a personal opinion, but it is not. To contain medical costs and provide a better standard of health care to the populations of the countries of the world, it is important to minimize the amount of time and money that health care workers spend diagnosing and treating side-effects --Jtclemens 17:52, 2 January 2006 (UTC)

does atorvastatin cause hypotension?
Q1i would like to know if there is a possibility that a administration of atorvostatin can cause hypotension. i do know of a person taking this drug, and shortly after that has been diagnosed with idiopathic hypotension. could the drug be a cause? it decreases synthesis of cholestrol, which is required for production of steroids like aldosterone which in turn regulates the blood pressure so i am curious if this affects the body's bp regulating mechanism

REF 1 Sir even i have observed same changes in two patients with exactly same situation, i think a research is required. 22nd november 2008


 * No, I like your theory but abnormal blood pressure is not commonly linked to atorvastatin. Aldosterone is present at very low amounts, and the amounts of cholesterol required for its production are minute. By the same token, patients would develop adrenal crisis due to decreased synthesis of cortisol. This is not a recognised problem in patients on statins. JFW | T@lk  23:23, 6 March 2006 (UTC)

Jtclemens and WP:V
seems to be of the idea that his opinion is automatically notable, and has gone as far as inserting this text on the article page: "This section has had important medical information for the potential patient deleted from it. Please check the history pages of this article for inforation concerning diagnostic tests and blood pressure information before starting any statin therapy." In addition, some unsourced misrepresentations were made (e.g. myopathy risk of 3%).

Most of this is nothing but WP:POINT, and repeated attempts to edit the article in this fashion will end up with WP:ANI and pushing for a block. JFW | T@lk  11:19, 11 June 2006 (UTC)

Dr. Wolff (JFW) Let’s start at the beginning and get to better know and understand each other. My name is James T. Clemens, PhD. I hold a Doctorate in Theoretical Physics and a minor in Mathematics from the Polytechnic Institute of Brooklyn (New York)- 1969. I have been a working scientist at the AT&T Bell Laboratories for 30 years (1969 -1999). I spent 15 years at the Bell Labs Branch in Allentown Pa. and then 15 years at the Murray Hill Branch, in Murray Hill, N. J. I have published many technical papers, given many invited technical talks, and participated in managing many technical conferences. I have been granted many patents and awards. I am a retired member of the Institute of Electrical and Electronic Engineers, where I held the position of Fellow and also The JJ Ebers Award Recipient – 1999. My fields of research have spanned nuclear structure, microelectronics, materials research, micro lithography (electron, optical, ion beam, and x-ray), photochemistry, and managerial psychology. I have studied at the Sloan School for Executive Management and also at the University of Tokyo’s Research Center for Advanced Science and Technology. I also presently read extensively in all fields of science and biology. Among my colleagues, there were at least 4 Nobel Laureates, who I interacted with on a daily basis. I am also known in the international academic circles. One of my best attributes as a scientist is to read complex sets of seemingly unrelated data and put the pieces together. You can "Google" me if you wish.

I guess I got used to people taking my comments and questions seriously and discussing them with me in a respectful manner.

So let’s begin a serious discussion of cholesterol and Lipitor therapy. I will limit myself to Lipitor since there are many statins, and many are derived from fungi. (This opens up the whole field of traditional Japanese dietary issues.) Lipitor is totally synthetic. Now let’s start with a brief discussion of good cholesterol and bad cholesterol. The discussion is over, since there are no such things. Let’s be specific, cholesterol is a unique molecule that has been identified – C24H46O. Its basic properties are that it is insoluble in water; it is a steroid (unique carbon ring structure) and contains a hydroxyl (OH) group. Cholesterol is used by the body in many ways, one of which is to maintain cellular health. In order for cholesterol to travel trough the blood stream it must complex with proteins, the complexes are water-soluble. Thus we get to terms such as High Density Lipoproteins Intermediate Density Lipoproteins, Low Density Lipoproteins.

I decided to write to you today, because of an advertisement in our local newspaper. It was 2 pages long. The newspaper is “The Newark Star Ledger” published daily and has a circulation of approximately 400,000 subscribers. The newspaper is located at 1 Star-Ledger Plaza, Newark, New Jersey 07102-1200. This area of New Jersey is interesting because it has a very high density of doctors and drug manufacturers.

Since I have been accused of speculation and not referencing anything, I am now referring to information contained in this advertisement by the Pfizer Corp. Therefore my reference is the newspaper, Pfizer Corp. “The Newark Star Ledger” June 25, 2006, Section One, pp. 21-22. The same advertisement has been run again on June 26, 2006.

I will quote exactly from the article – which is now verifiable!

“The evidence for Lipitor is impressive. Along with diet and exercise, Lipitor lowers bad cholesterol 39-60%. And Lipitor is clinically proven to reduce the risk of heart attack and stroke, if you have several common risk factors for heart disease. These risks include family history, high blood pressure, age, low HDL or smoking.”

JTC comment – note the mixed use of wording “bad cholesterol” and then “HDL”. Why not stay consistent with LDL and HDL? Can you explain this? Maybe they want to use the word “bad”.

“IMPORTANT INFORMATION: LIPITOR is a prescription drug. It is used in patients with multiple risk factors for heart disease such as family history, high blood pressure, age, low HDL or smoking to reduce the risk of heart attack and stroke. When diet and exercise alone are not enough, LIPITOR is used along with a low-fat diet and exercise to lower cholesterol.

LIPITOR is not for everyone. It is not for those with liver problems. And it is not for women who are nursing, pregnant or may become pregnant. If you take LIPITOR, tell your doctor if you feel any new muscle pain or weakness. This could be a sign of rare but serious muscle side effects.”

JTC Comment – Pfizer is now being very specific about several issues. First, Lipitor is a prescription drug. Everybody knows that! JFW would definitely say, “strike it out – everybody knows that”. Right – so why does Pfizer restate it? Second, they are repeating the risk factors, why?

Pfizer is using the standard corporate legal defense of publicly announcing in newspapers that the drug should only be used for certain subgroups of the population. If they are sued because of severe reactions, they will state that they made every effort, including the newspapers to inform the public. Then they argue that the patient did not see his physician fast enough and it is not their fault.

Third, they are stating it is not for everyone, and specifically mention women nursing and pregnant. Also people with liver problems. Now I have a problem with “and women who may become pregnant.” What do they mean by that – really, scientifically what does that mean? Does it cause problems becoming pregnant, does it cause fetal problems, does the woman become ill? Pfizer does not answer that question, however in its extended web site, it speculates that women with infants (nursing mothers), pregnant women, and those who could become pregnant will need high levels of cholesterol for proper fetal or infant development. Thus they recommend complete stoppage of Lipitor therapy. Pfizer implicitly is stating that they know that Lipitor and other statins have the possible potential to cause very severe medical problems for fetuses and infants, due to an insufficient level of cholesterol in the bloodstream. Since they are concerned about that, then they know that inadequate supplies of cholesterol in any blood system, slows muscle cell development or growth, and can lead to damage. They are admitting that cholesterol reduction should only be undertaken if a person has more than an adequate amount of cholesterol in their body. It’s pretty obvious – right? Now let’s not discuss proper cholesterol levels, since each person is different and very complex. Medical guidelines are constantly changing and cannot be applied to a specific person. They can represent a population of people. That is about all they can do. Fourth, they are now splitting out the muscle pain or weakness issue from the “normal” side effects, by placing it the IMPORTANT INFORMATION SECTION. This development by Pfizer is totally consistent with their pregnancy speculation. They realize that a portion of the population has just an adequate supply of cholesterol in their bodies. If this adequate supply is reduced below a critical value then muscular pain (origin of which has not been identified) and myopathy occur. Once those symptoms appear, statin therapy must be stopped. Recovery from the damage is only partial – reference: J.T. Clemens Wikipedia –Lipitor Discussion. Notes in Discussion on Partial Reversal of Muscle Damage.

“Tell your doctor about all of the medicines you take. This may help avoid serious drug interactions. Your doctor should do blood tests to check your liver function before and during treatment and may adjust your dose. The most common side effects are gas, constipation, stomach pain and heartburn. They tend to be mild and often go away.”

JTC Comment – Now if I understand this first part correctly, they are stating that there are lots of drugs that can have interaction effects. I think that is obvious, since the body is a complex biological system and cannot be treated or modeled as a simple linear system. This is obvious to me, is it obvious to you? JFW tell Pfizer to “strike it!” (Sorry, I am being sarcastic.) The same logic applies to the liver tests – right? But don’t forget that this article is a legal defense publication strategy. Redundancy is good in this case. Finally keep in mind these common side effects – they tend to be mild and often go away. So given this statement, there would be no reason to stop Lipitor therapy, not when one is dealing with CHD.

Newark – Star Ledger, June 25, 2006, Section One pp 22

(NOTE - This page contains additional fine print about Lipitor. The quotations are from various sections.)

Who is Lipitor For Who should not Take Lipitor Lipitor may harm your unborn baby. Lipitor can pass into your breast milk and may harm your baby.

Possible Side Effects Muscle Problems Liver Problems The Most Common Side Effects “Side effects are usually mild and may go away by themselves. Fewer than 3 people out of 100 stopped taking LIPITOR because of side effects.”

JTC Comment – Well in this section Pfizer is more explicit about the effects of Lipitor with respect to women. Lipitor has the potential to cause fetal and post fetal difficulties in early infant development. Pfizer does not want any women who are nursing, pregnant, or considering having a baby to take Lipitor. It sure sounds like the dangers to the coming child are pretty serious – Right?

Now why did slightly less than 3% of the patients stop Lipitor therapy? I really don’t believe it is because they have indigestion. Take a Tums! By their earlier statement Pfizer states that the common side effects are mild and tend to go away. The only reason left is that severe muscle pain mylgia – the onset of myopathy, in addition to clinical myopathy, that clogs the kidneys with debris and slows their function. Persons can die from liver failure (rhabdomyolysis), and they have in the early works with statins. Reference not needed. Obvious –right

I derived the number of 3% by analyzing Pfizer’s large matrices of side effects. I would suggest that you go back and read the Lipitor web pages very carefully. You may come to the same conclusion. Pfizer has! Now there is repeated reference to a 3% number.

JTC Summary – Over the past three years I have learned a lot about CHD, atheromas, and statin drugs. I learned that a simple test such as a Doppler Sonogram can readily see if there is a major development of atheromas, in my case the carotid artery. If atheromas are not present, and if the patient is asymptomatic, then is there a need for Lipitor therapy? Pfizer would argue that there is, since, in a case like myself, I have several risk factors – male, over 55. But the probability of my having a heart attack in the next ten years is 10% or less. Right?

Science does not know what causes the formation of atheromas that lie within the arterial walls between the endothelium lining of the artery and the smooth muscle wall. They contain macrophage white blood cells, crystallized cholesterol and also calcium. And the process begins as the child begins to enter into puberty (ages 5 – 9). It is a chronic disease, a long-term problem. As I studied the subject it reminded me of acne, another inflammatory disease that starts in puberty. We may be all surprised someday to learn that these problems are caused by either genetic issues, toxins, or possibly by viruses, or some other pathogen. How long did it take the medical community to accept the research that proved that most stomach ulcers are caused by a bacterium and could be easily cured by an antibiotic?

At this point I will not go into a discussion o the role of NO – nitric acid. But it is interesting that heart disease is generally decreasing in the overall population, since the 1960/1970 period. It was at this time that catalytic converters were required in new automobiles to eliminate the NO combustion by-product.

The bottom line is that Pfizer is a corporation; and as such its basic mission is to create wealth for the investor. It can do that by various ways, but if it chooses to develop drugs, then it has a social responsibility to be very careful about their potential use, and minimize adverse side effects. Any information provided to the public about any medication should contain to-date, complete information about the disease and conditions for clinical use of the medication. Information that is truncated can lead to the improper use of the medication. This is my objection to the Wikipedia Lipitor page, as it is my objection to any page in Wikipedia that describes drugs or chemicals, without providing all safety and danger information about the material. Dr. Wolff it is you responsibility to make sure that the Wikipedia page is totally consistent with the Pfizer’s Lipitor Web Page, the Wikipedia article can contain additional information, but there is no moral or scientific justification to truncate information or data. It is professionally irresponsible.

I have no ill will with Pfizer and any other drug company as long as they are forthright about the information they possess and release important information to the public. There are too many examples of the opposite case, and the lawsuits are staggering in quantity and scope. Consider the example of Vioxx!

I will finish my personal discussion of my case in the Discussion Section. It is now closed. After statin therapy, adverse reaction, refusal to take Zetia, dared to take stress tests, regular and MRI, and then my own initiated Doppler carotid sonograms, my doctor has stated: “Jim, after all of this, I can tell you that you will not die of CHD this year, you may have a heart attack when you are 85 years old, but your arteries are amazingly clean and free of atheromas.” It is based upon this whole sequence of events and individual reading, I believe that the medical process for the administration of a statin drug in an adult male should be, first start with a complete lipid profile, then an inexpensive Doppler carotid sonogram, if warranted, follow up with an MRI stress test, and finally administration of a statin with very close monitoring.

Dr Wolff, how would you like it, if I stood up at an international conference with an audience of 2,000 (I did this when I accepted the Ebers Award) and announce that I would like to thank my physician for his laxity, lack of a logical process for the administration of a powerful drug, and the subsequent inducement of arthritis in both my hands. I would never do this. However, in the physical sciences every researcher that writes a paper or presents a talk at a conference, is carefully evaluated by his peers, of all different ability. I am very careful about what I write, and I read every sentence multiple times to check for accuracy and consistency. Thus my international reputation.

So let’s part peacefully. I will no longer write anything for Wikipedia. I am not impressed by the overall quality of most articles. There are a few good ones, but I have noticed that most articles are not written by the leading researchers and experts in their respective fields. There is just too much inaccurate science in the majority of them.

Jtclemens 17:12, 26 June 2006 (UTC)


 * I have no desire to address every single point in this epistle. Contrary to yourself my only qualifications are a lowly medical degree, but your approach to medical science is not quite standard and Wikipedia is certainly not the vehicle to publicise this approach. Please review our most vital content guidelines: WP:NPOV, WP:NOR and WP:V. If you have calculated a myopathy risk of 3% this is WP:NOR. We're not a discussion board. I'm delighted to discuss medical science, but not at the expense of writing encyclopedia articles. JFW | T@lk  23:02, 13 July 2006 (UTC)

May I request the opinion of the readers of this forum on a related topic? I work for a publisher of drug information that is free on the Web and whose editors are trying to represent a balanced view for point-of-care use (ie, not influenced by pharma money, plan money, etc.). This information is used currently by hundreds of thousands of MD's. It includes off-label information on usage and side-effects (eg) that they consider useful, and which in general I have not seen in external link landing pages. Recently a number of our MD users have asked if we can put links to this information in Wikipedia drug articles. Hence my request for opinions here. This is not against Wikipedia policy, as I understand it, if our users are posting the links (and not us), but I have no wish to suggest that they do this (or tell them how) if the links are going to be yanked fairly reliably. Thoughts on this, folks? Thanks. Irwinstreet 20:23, 13 September 2006 (UTC)

i think that the molecular weight of this compound is wrong. according to mosby's drug consult, atorvastatin calcium is 1209.42. i don't think the calcium is going to add 600+ MW units


 * No, it's right for atorvastatin by itself. However, the atorvastatin calcium complex contains 2 molecules of atorvastatin, 1 calcium, and 3 waters, which total 1209 mass units. —Preceding unsigned comment added by 63.125.124.226 (talk) 12:56, 18 January 2008 (UTC)

simvastatin generic alternative.
Sorry, what's the rationale exactly behind this deletion of sourced material? -- Kendrick7talk 23:45, 3 November 2007 (UTC)


 * It is incomplete. You cannot just build this on a single newspaper article. Before doing this, we should at least attempt to demonstrate whether these drugs are indeed interchangeable. In the UK, there is a strong drive for patients on statins to switch to simvastatin. There are, however, trials that demonstrate a superiority of atorvastatin over simvastatin in certain situations (e.g. acute coronary syndrome). Newspaper articles can be useful, but this article refers to numerous research studies without even mentioning when and where they were published. JFW | T@lk  23:56, 3 November 2007 (UTC)
 * Er, what you deleted already said all that about the British study. Per WP:TIND, incompleteness isn't a particularly good rationale for deleting sourced information. Feel free to add sources contradicting or supplementing the NYT article if you would like though. -- Kendrick7talk 00:12, 4 November 2007 (UTC)

Your addition simply lacks context, and that is unfortunate. I will have to chase some references, e.g. whether the MIRACL study demonstrates my point, but I would generally urge caution in using newspaper articles when primary sources tend to be much more accurate. JFW | T@lk  00:34, 4 November 2007 (UTC)
 * I understand that. Certainly while we should generally be relying on secondary sources, I appreciate that newspapers to have a reputation for getting their facts crossed when it comes to medical topics. -- Kendrick7talk 00:50, 4 November 2007 (UTC)

I think an undisputed fact is that atorvastatin is facing competition from simvastatin. The wording can be revised to avoid giving the impression that they are fully interchangeable (unless solid sources back up that claim), but the mention of simvastatin is relevant and should not be removed. --Itub 12:53, 5 November 2007 (UTC)

Simvastatin and atorvastatin are not interchangable, they are different chemical entities. That must mean that while they are both drugs in the statin class, simvastatin is not a true generic version of atorvastatin. Correct —Preceding unsigned comment added by 222.154.182.109 (talk) 04:44, 27 December 2007 (UTC)

Whoa
Studies in bone marrow transplant JFW | T@lk  06:45, 5 December 2007 (UTC)


 * Interesting stuff. For others, like myself, unfamiliar with the somewhat new(?) concept of graft versus leukemia, here's a useful explanation. -- Kendrick7talk 17:18, 5 December 2007 (UTC)

FDA Ongoing Review of Vytorin
Released Jan 25th 2008

Preliminary results from a study comparing Zocor and Vytorin show no significant difference on the build up of cholesterol plaque in the carotid arteries. link: http://www.fda.gov/bbs/topics/NEWS/2008/NEW01784.html


 * But this is the talkpage about atorvastatin. And IMT is not the gold standard for measuring statin efficacy. Mortality and cardiac events are. JFW | T@lk  20:58, 25 February 2008 (UTC)

Adverse effects
This section is troubling because it doesn't seem to have an even enough tone yet, and the facts that are mentioned (while potentially true) are not individually verified. The claims made in this section are very strong and seem to require a fair degree of medical expertise; I certainly couldn't say whether the trade-off between cancer risk and heart disease risk is worth it. If the claims can be sourced and present a more even-handed view of the issues associated with the adverse effects from Atorvastatin.

-Yitzhak1995 (talk) 18:26, 9 May 2008 (UTC)


 * Large studies have shown that cancer risk is not elevated. The content that you saw has been removed because the sources are not reliable. JFW | T@lk  21:57, 13 May 2008 (UTC)

Adverse effects
Lipor's own longterm studies are inconclusive because they are only done on limited groups and and longevity is only 4-5 years. Most of the cancer cases associated with lipitor appear during the 6-8 year period. Several independent studies have tested statins, including lipitor and have shown that user will develop cancer with normal use, especially if the subject is middleaged, female, and going through menopause. Other, independent review of lipitor from independent users also confirm the risk of cancer taking lipitor.

Studies done by Shane Ellison M. Sc. http://www.vegsource.com/talk/campbell/messages/9275.html The book cited in this article is available on amazon and free ebook format

Amazon http://www.amazon.com/gp/product/product-description/0977207927/ref=dp_proddesc_0?ie=UTF8&n=283155&s=books

eBook http://www.health-fx.net/eBook.pdf

This information is also available thoughout these artiles 1 Newman, Thomas B. et al. Carcinogenicity of Lipid-Lowering Drugs. JAMA. January 3, 1996-Vol 275, No. 1. 2 Ravnskov, Uffe. Statins as the new aspirin. Letters. BMJ. 2002; 324:789 (30 March). 3 Law, M.R. et al. Quantifying effect of statins on low-density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003 June 28; 326 (7404): 1423. 4 Akagi K. et al. Vascular endothelial growth factor-C (VEGF-C) expression in human colorectal cancer tissues. Br J Cancer. 2000 Oct; 83 (7):887-91. 5 Nature Medicine September, 2000;6:965-966, 1004-1010. 6 Sternberg, Steve. USA Today. 08/20/2001.

This states a study made made by JAMA that includes the use of statins on rats and the side effects. http://www.hoptechno.com/statinsheets.htm

This states the use of statins in low LDL patients and it increasing the risk of cancer. http://www.timesonline.co.uk/tol/life_and_style/health/article2127605.ece

This lists studies done by the New England Journal of Medicine, and Journal of the American College of Cardiology that indicate the toxicity of Lipitor and other statins. www.naturalnews.com/023176.html

This lists a study done by Dr. Alsheikh-Ali. Similarly as the other studies before it states 2 core detail. There is an inverse relationship between the use of lipitor to lower cholesterol and cancer diagnosis. Meaning, as the user continues to use lipitor to lower his/her cholesterol, his/her risk of cancer heightens. The second core detail is that overdoses of lipitor causes liver cancer. http://www.medicationsense.com/articles/jul_dec_07/statin_cancer101907.html

Some more soreces stating the same thing as Dr. Alsheikh-Ali.

1. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. New England Journal of Medicine 2005;352:1425?]35. 2. Stroke prevention by aggressive reduction in cholesterol levels investigators. High?]dose atorvastatin after stroke or transient ischemic hepatic. New England Journal of Medicine 2006;355:549?]559. 3. Alsheikh-Ali AA, Maddukuri PR, Han H, et al. Effect of the magnitude of lipid lowering on risk of elevated liver enzymes, rhabdomyolysis, and cancer. Journal of the American College of Cardiology 2007;50:409-18. 4. LaRosa JC. Means and ends of statins and low-density lipoprotein cholesterol lowering. Journal of the American College of Cardiology 2007;50:419-20. 5. Pitt B.  Low-density lipoprotein cholesterol in patients with stable coronary heart disease -- is it time to shift our goals? New England Journal of Medicine 2005;352(14):1483-1484.

There is also this article http://www.newmediaexplorer.org/chris/2003/11/07/bad_news_about_statin_drugs.htm

and this article http://www.newmediaexplorer.org/sepp/2004/01/31/lipitor_the_human_cost.htm

Wikipedias OWN statin page http://en.wikipedia.org/wiki/Statin

Drs. Takahashi and Nishibori study that suggest that statins, such as lipitor promote cancer in certain segments of the population.

The origional book that revealed muscular degeneration, which is listed as on of the adverse effects for Atorvastatin LIPITOR,® THIEF OF MEMORY There is a new book, and the author changed the title, but it lists cancer now. Statin Drugs: Side Effects and the Misguided War on Cholesterol

Some fact and opinionated articles, but many user reviews do confirm cancer as a possible side effect, among many others. http://www.captainclark.com/Pages/lipitorhorror.html http://www.worldhealth.net/news/lipitor_zocor_pravachol_cholesterol_lowe

So as you can see, cancer of the liver and colon-rectum should be listed as a possible adverse effect that may appear in a certain segment of the population. The prolonged use of lipitor will not reduce the risk of mortality, and in fact, these studies have confirmed that mortality actually stays the same, if not increases due to the trade off, not to mention the part about the overdose which also confirms the cancer risk. Some other drugs do not cause any cancer if overdosed in humans and animals, but may cause mortality. Lipitor will cause both.

With this evidence, I request that a short sentence about liver and colon-rectal, including the inverse correlation, animal testing (including CARE and PROPER independent tests), and overdosing be included under adverse effects, not to mention the sources.

-Shdwsclan (talk) 20:05, 13 May 2008 (UTC)

Additionally, the pre-corrupt (before nixon) FDA would of never allowed lipitor on the market, due to it being considered a carcinogen. Lipitor has been proven to cause liver cancer in rats, in human quantities. Sassafras or more commonly Safrole Oil was benned in the USA (by the pre-nixon FDA) for this EXACT reason....that human doses caused caused liver cancer in RATS, as does lipitor. So why is not lipitor banned? Corruption. The very least, it should carry a warning.

-Shdwsclan (talk) 10:43, 18 May 2008 (UTC)

12. Side Effects: Memory Problems?
I was commiserating with a friend about my memory problems. My vocabulary was greatly reduced. I would sometimes be driving on well traveled roads within a few miles of my home and not recognize where I was. I couldn't remember the name of my favorite beer. I thought I was pre-Alzheimer. My friend said that his memory was also getting bad and ask if I took Lipitor. He said he thought that Lipitor was his problem but he had a family history of heart problems and was afraid not to take it. I did some research. You need cholesterol for memory. Also, I found a book titled "Lipitor, Thief of Memory" written by an ex-Astronaut, MD. I never bought the book, but the man's story was compelling. I talked to my doctor and she said I could stop taking my lipitor for a couple of months and see what happens. After about six weeks it was like I had an epiphany. I could remember stuff again. I think that I could actually sense the difference. I switched to two other non-statin drugs and together they do the job for my cholesterol level.

After my experience, I am starting to wonder if Lipitor is dumbing down America. Google "lipitor memory" if you're interested. At any rate I hope that someone with a better pharma or chemistry background than me might identify credible research in the area and add it to this article as a public service.

H.E. Hall (talk) 20:42, 1 August 2008 (UTC)cheers, HH I added a few links to section titled "External Links". H.E. Hall (talk) 21:48, 1 August 2008 (UTC)HH

I replaced the links I created to articles about memory loss associated with statin drugs that were deleted by Wolff who is a Dutch physician that evidently does not want to see links to sources about this topic from credible sources like the Wall St. Journal. I had even included one article with a contrary opinion. Here is Mr. Wolff's reason for his edit: "some others say that it prevents Alzheimer's - how odd". I think it very odd that you remove these links. H.E. Hall (talk) 21:54, 4 August 2008 (UTC) -cheers, H. Hall


 * Firstly, assume good faith; I am sympathetic to your personal situation, but I request that you hear me out on how to deal with this.
 * Secondly, please note my comment on your talkpage about using the "external links" version to discuss issues that perhaps ought to be dealt with the article body itself.
 * Thirdly, large neutral statin studies (using validated neuropsychological tests) have not reliably shown any influence on memory by statins; in fact, some studies show that statin use reduces risk of AD. If you want to write a truly neutral section on Lipitor and memory, all these issues need to be addressed. Let me know if you need help with this. JFW | T@lk  07:10, 5 August 2008 (UTC)

Atorvastatin and grapefruit juice
A passage from the article
 * The main clinical advantage of Lipitor over Simvastatin is that it is not metabolised by certain liver enzymes, and thus its blood concentration is not increased when combined with grapefruit juice which inhibits these enzymes. Simvastatin patients should avoid drinking large amounts of grapefruit juice for this reason. An independent analysis showed that, at commonly prescribed doses, atorvastatin and simvastatin have no statistically significant differences in reducing cardiovascular morbidity and mortality.
 * Source: Zhou Z, Rahme E, Pilote L (2006). "Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention". Am. Heart J. 151 (2): 273–81. doi:10.1016/j.ahj.2005.04.003.

This information though sourced is not corroborated by other sources on grapefruit-drug interactions available on the net. Generally most statins' bioavailability is markedly increased by grapefruit with exceptions of pravastatin, possibly rosuvastatin and fluvastatin as well. Atorvastatin is quite uniformly described as being influenced by this interaction. Studies on healthy subjects are rather scarce but most authorities, I think, prefer to err on the safe side. Like RxList. I propose a re-write of the passage. Kpjas (talk) 07:53, 16 September 2008 (UTC)