I take atorvastatin and I get muscle pains in my thighs. I was also prescribed amlodipine, even though the leaflet says they should not be given together. I believe atorvastatin works in the liver and other statins work in the intestines – does this change the side-effects?
Name and address supplied.
Dr Martin Scurr replies: Statins cause a lot of confusion, as there is much misinformation about these drugs, the benefits and the potential side-effects.
First, to the amlodipine – it’s not that you can’t take it when on atorvastatin, as in fact the two drugs are often prescribed together for treating high blood pressure and high cholesterol, both cardiovascular risks.
However, amlodipine does slightly increase the level of atorvastatin in the blood by inhibiting its metabolism in the liver (the two drugs compete for an enzyme, CYP3A4, which is how the liver clears drugs from your body).
It is possible that this interaction increases the likelihood of statin-related side-effects, such as the muscle pain you describe. However, the benefits of the two drugs still outweigh the risks.
As for your side-effect question, the different mechanisms you refer to are for statins versus ezetimibe, another type of cholesterol-lowering drug.
Statins work by inhibiting an enzyme in the liver that’s involved in breaking down cholesterol. The liver compensates for this by increasing receptors for ‘bad’ LDL cholesterol on the surface of liver cells. These bind and remove LDL from the bloodstream, resulting in lower levels. Statins also slightly increase levels of ‘good’ HDL cholesterol.
Dr Martin Scurr replies: Statins cause a lot of confusion, as there is much misinformation about these drugs, the benefits and the potential side-effects
There are five statins available and none is superior over another in terms of side-effects.
Patients who find the muscle-pain side-effects of statins intolerable are often prescribed ezetimibe instead. While it also lowers cholesterol, it does so by inhibiting the absorption of cholesterol in the small intestine. Then, as with statins, the liver responds by enhancing the LDL receptors on the liver cells, increasing the removal of LDL cholesterol from the blood. But it doesn’t have any significant impact on HDL cholesterol.
I’d suggest discussing this with your GP – it may be that you will find a lower dose of atorvastatin tolerable, and taken in conjunction with ezetimibe, this could work well.
I’m 77 and went to see my GP because I could not put my head down on my pillow without pain, while also getting very dizzy when turning over in bed. A CT scan was clear. My GP has no idea what’s wrong, and I feel like I’m at a dead end.
Ann Pearce, West Yorkshire.
I wonder if in fact you have two separate conditions – one causing the pain, the other the dizziness.
It’s possible that your head pain is occipital neuralgia, chronic pain in the back of the head and upper neck that often extends forwards over the top of the head.
It is caused by irritation of the occipital nerves, which run from the upper spine through the scalp – some people experience a constant dull ache or severe, sporadic jabbing pain that can be triggered by movement of the head. Usually in someone your age it’s caused by osteoarthritis in the bones of the neck.
Treatments range from a regular dose of an anti-inflammatory agent such as ibuprofen, four times daily, to injections with local anaesthetic around the occipital nerves (which may banish the pain completely until it wears off, usually after two days – though only a neurologist should administer it).
Other possibilities include physiotherapy and stronger drugs specifically aimed at neuralgic pain, such as gabapentin or pregabalin.
As for the dizziness, this may be benign positional vertigo, similar to motion sickness. It can develop when crystals form in the fluid inside the inner ear canals, which govern balance.
This can be readily remedied by a GP or nurse familiar with a specialist technique known as the Epley manoeuvre – a series of movements of the head to dislodge the crystals (or you might be referred to a specialist for the treatment).
Hopefully, these suggestions will help you to get some relief.
In my view… drug for hot flushes may replace HRT
I receive many letters from readers severely troubled by hot flushes – in some cases these can last for years, often coinciding with heavy sweats that are deeply embarrassing.
Hormone replacement therapy (HRT) can help, though not always, and not all women want to take it. Until now, the only other medication of any use for this has been the antidepressant venlafaxine.
These flushes occur as a result of the decline in oestrogen levels affecting the thermoregulatory centre in the brain, which maintains body temperature.
Now there’s a new drug that targets this pathway – fezolinetant, which is taken as a daily tablet. It has been shown to reduce daily flushes from ten or more down to fewer than three.
This represents a real advance for those in extreme discomfort without a satisfactory solution. I anticipate it will only be a matter of time before it’s approved.
