Dear Dr. Roach: I’m a 93-year-old woman in good health. I take 40 mg of lovastatin once a day for high cholesterol, but my cholesterol levels are always high when tested. My physician is not concerned, but I am. Why isn’t lovastatin bringing down my cholesterol levels to normal?
S.A.
Lovastatin (Mevacor) was the first statin drug approved, but newer statin drugs are more potent and have less likelihood of side effects.
So, I don’t have a single patient on lovastatin anymore. Still, you can be sure that your cholesterol level would be higher if you were to stop lovastatin.
If you wanted, you could switch to a more potent agent, such as rosuvastatin or atorvastatin, which would very likely bring your cholesterol level down even further.
However, the data on people in your age group are really lacking. We don’t know whether lovastatin is really helping you. Some of my patients in their 80s and 90s prefer to keep taking it, and the data shows that they continue to help prevent heart attacks in older people. Statins are particularly useful in people at a higher risk. However, some prefer to get off the medicine, especially if it is causing side effects or interacting with another medicine.
Dear Dr. Roach: I have really bad side effects with levothyroxine and Synthroid. Is Cytomel an option? Are there other medications?
P.L.
There are two main thyroid hormones (levothyroxine and triiodothyronine) that are used for thyroid replacement therapy. The standard is levothyroxine, also called T4, and a very common brand name of levothyroxine is Synthroid. T4 does not have much thyroid activity itself, but it is converted in the body to the active form of the hormone, triiodothyronine, also called T3. T3 is also available under the brand name Cytomel (a biologically equivalent, synthetic form of T3, also called liothyronine).
T4 is the standard treatment because it uses the body’s own mechanism to make the active hormone. T3 is absorbed quickly and metabolized rapidly, which can lead to fluctuations in the thyroid hormone during the day, even if it’s dosed twice daily. Moreover, people treated with T3 had a higher risk of heart failure and stroke compared to T4 users, probably because they had too much thyroid hormone during the day.
I don’t know which side effects you are having. Occasionally, I see a person respond well to one manufacturer of thyroxine, and I will ask the pharmacist to fill the prescription with that manufacturer instead.
Dear Dr. Roach: I’m writing about a recent answer you gave in regard to sunbathing. I’ve heard that sunbathing for a brief period each day (e.g., 10 minutes) is the best way to get vitamin D. What are your thoughts on this?
C.S.
Most people do not need to worry about vitamin D. Ten minutes of sun exposure to your hands and face are adequate enough to get the vitamin D you need. Supplemental vitamin D wasn’t found to provide a benefit in a recent large study, so I wouldn’t take the risk of getting sun damage by sunbathing, even it’s for 10 minutes, if your goal is to get more vitamin D.
People who do need to consider getting more vitamin D include those with osteoporosis; people who get no sun at all (whether they are homebound, live in an institution, or wear sun-protective clothing); people who can’t absorb vitamins (celiacs or those who undergo bariatric surgery); and people who take medicines that accelerate vitamin D metabolism (seizure drugs like carbamazepine). A vitamin D level is indicated in these cases.
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