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Compatibility of commonly used drugs in lactation
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
There is no research on the use of statins during breastfeeding. Cholesterol is important to the development of the baby and the long-term effects of lowered levels are unknown. Simvastatin – oral bioavailability 5%, PPB 95%, no studies. Atorvastatin – oral bioavailability 14%, PPB >98%, no studies. Pravastatin – oral bioavailability 17%, PPB 50%, no studies. Rosuvastatin – oral bioavailability 20%, PPB 88%, RID 0.6–0.77%. Study of one patient but baby was not breastfed so no outcome data.
Diagnosis
Published in Wilfrid Treasure, Roger Jones, Diagnosis and Risk Management in Primary Care, 2017
In time, the diagnosis might be refined, changed fundamentally, or overshadowed by a new diagnosis, depending on which outcomes we’re considering. Pravastatin prevents cardiovascular death in the elderly without affecting overall mortality.135 We might therefore judge it unsuitable for all elderly patients or suitable only for those in whom vascular risk exceeds risk from other diseases. If the patient develops incurable cancer, the risk of dying from that might overwhelm their risk of a vascular death and prompt us to stop their pravastatin.136 The diagnosis in this situation, therefore, might be ‘not for vascular prevention’.
Antiphospholipid Syndrome: Management of the Obstetric Patient
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Ashley E. Benson, D. Ware Branch
Clinicians have sought and tried alternative “treatments” in high-risk obstetric APS cases and patients refractory to treatment with heparin LMWH and LDA. These alternative treatments are nearly always in addition to a heparin agent and LDA. Cautious interpretation of reports regarding such alternative treatments is in order because they are anecdotal or retrospective in nature and have not included proper comparison to patients matched for confounders known to be associated with adverse pregnancy outcomes of interest. Investigators have reported modestly improved pregnancy outcomes adding low-dose prednisolone (10 mg per day until 14 weeks) [47] or hydroxychloroquine (HCQ) [48] to heparin LMWH and LDA. A more recent retrospective international multicenter study of high-risk APS pregnancies concluded that the addition of HCQ treatment was associated with a significantly higher live birth rate in women with a history of one or more pregnancies refractory to conventional therapy [49], although this report did not take account of embryonic aneuploidy as a cause of miscarriage. Varying degrees of successful pregnancy outcomes have been reported in retrospective case series of high-risk or refractory obstetric APS using intravenous immunoglobulin (IVIG) infusions and/or apheresis [50–57]. Most recently, a retrospective multicenter study found that triple-positive APS patients with previous thrombosis treated with additional therapies had a significantly higher live birth rate compared to those receiving conventional therapy alone [58]. Finally, improved outcomes in APS pregnancies treated with pravastatin has been reported by one group [59].
Advances with lipid-lowering drugs for pediatric patients with familial hypercholesterolemia
Published in Expert Opinion on Pharmacotherapy, 2021
Filipe Ferrari, Vítor M. Martins, Viviane Z. Rocha, Raul D. Santos
Wiegman et al [28]. followed more than 200 children (8 to 18 years old) with FH to evaluate the effects of pravastatin therapy for 2 years in a randomized, double-blind clinical trial conducted in the Netherlands. The study patients received pravastatin 20–40 mg or placebo. While carotid intima-media thickness, an accepted surrogate biomarker of atherosclerosis in children, showed a regression tendency with pravastatin (mean reduction of −0.010 mm), progression was observed in the placebo group (mean of +0.005 mm). In addition, the pravastatin group showed an average LDL-C reduction of 24.1% versus a 0.3% increase with placebo. Importantly, the 2-year treatment was safe and no adverse events in growth, muscle, or liver enzymes were reported. Subsequently, this same group of children was reevaluated after an average treatment period of 4.5 years [56]. Early onset of statin treatment was associated with improvement in carotid intima-media thickness, suggesting that early onset of statin therapy may be beneficial in preventing atherosclerosis development in adolescence.
Statin use and safety concerns: an overview of the past, present, and the future
Published in Expert Opinion on Drug Safety, 2020
Rubina Mulchandani, Tanica Lyngdoh, Ashish Kumar Kakkar
The mechanisms involved in statin-induced liver toxicity are complex and continue to remain under investigation. Few animal studies have reported reduced mevalonate or its sterol intermediates as the underlying cause for elevation in liver enzymes. Another study explains a possible correlation between changes in the lipid composition of the liver cell membrane and increased permeability and leakage of the transaminases [31,62]. Pravastatin has been shown to induce hepatic mitochondrial redox imbalance in the animal model of human familial hypercholesterolemia, a possible mechanism of its liver toxicity. Dietary supplementation with antioxidants coenzyme Q10 or creatine was shown to reverse these changes indicating that mevalonate pathway may not explain the statin-induced hepatic adverse effects completely [63].
Evidence and mechanisms for statin-induced cognitive decline
Published in Expert Review of Clinical Pharmacology, 2019
Brendan Tan, Franklin Rosenfeldt, Ruchong Ou, Con Stough
In another large-scale trial, the Prospective Study of Pravastatin in the Elderly at risk of Vascular Disease (PROSPER), Shephard et al. studied 5804 patients aged 70–82 years with a history of risk factors for vascular disease [32]. Patients were randomized to either statin therapy (40 mg/day pravastatin) or a placebo and followed for an average of 3.2 years. The main finding of the study was that Pravastatin significantly lowered LDL cholesterol levels. However, in the secondary outcomes of the study, it was found that Pravastatin had no significant effects on cognition as measured by the MMSE, word recall tasks or performance time. However, cognition was only a secondary outcome and the battery of tests used was not comprehensive. The Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the elderly but is only useful as a screening test not as a sensitive test of cognitive impairment.