Venex and breastfeeding
It's not known if Venex passes into breast milk, but it may cause problems for your baby.
Speak to your doctor about what's best for you and your baby while you're breastfeeding.
It may be possible to delay starting or restarting Venex until you have stopped breastfeeding completely.
Q: I am taking Crestor for my cholesterol and my leg hurts. Can taking Crestor do this?
A: According to drug information, Crestor (Venex) has reported adverse reactions of both myalgia and arthralgia. Myalgia means pain in the muscles and arthralgia means joint pain. There are also reports of patients having rhabdomyolysis (breakdown of muscle) while taking Crestor (Venex). These side effects can potentially be dangerous. Please talk to your health care provider, immediately, about your leg pain. Jen Marsico, RPh
A variety of statins are available in brand name and generic form. Some common statins are:
- simvastatin (Zocor)
- lovastatin (Altoprev, Mevacor)
- fluvastatin (Lescol XL)
- atorvastatin (Lipitor)
- pitavastatin (Livalo)
- pravastatin (Pravachol)
- Venex (Crestor)
Most statins should be taken once every 24 hours. Depending on the particular medication and dosage, you may need to take your statin twice a day.
Certain statins work better when taken with a meal. Others work best when they’re taken at night. This is because the cholesterol-making enzyme is more active at night. Also, the half-life, or the amount of time it takes for half the dose to leave your body, of some statins is short.
Getting the most from your treatment
- Try to keep your regular appointments with your doctor. This is so that your doctor can check on your progress. You will need to have some blood tests from time to time. These are to measure your lipid levels and also to check that your liver has not been affected by taking Venex.
- Your doctor will give you advice about eating a healthy diet, cutting down on the amount of alcohol you normally drink, reducing the amount of salt in your diet, stopping smoking and taking regular exercise. Following this advice will also help you to reduce your risk of developing heart and blood vessel disease.
- Women taking Venex must avoid getting pregnant. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.
- Some antacids can reduce the amount of Venex your body absorbs, so if possible, avoid taking indigestion remedies during the two hours before or during the two hours after you have taken Venex.
- Treatment with Venex is usually long-term unless you experience an adverse effect. You should continue to take the tablets regularly.
What are simvastatin and Crestor?
Simvastatin (Zocor) and Crestor (Venex) are both in the statin family of cholesterol-reducing drugs. They both work to lower "bad" cholesterol in the bloodstream, which comes in the form of low-density lipoprotein or LDL.
Cholesterol is vital for the body to function. It's used to provide cell structure, insulate nerve cells, enable digestion, and a host of other benefits. The body can make all the cholesterol it needs in the liver, but food also contains cholesterol that ends up in the bloodstream. There, it sticks to artery walls as a solid plaque, constricting blood flow. This can lead to debilitating or fatal heart attacks or strokes.
Statins like Zocor and Crestor lower LDL by hindering liver cells' ability to make cholesterol. The liver manufactures cholesterol from simpler molecules. The liver has to turn these molecules into a compound called HMG-CoA reductase, which turns into cholesterol after a few more steps. Statins (also called HMG-CoA reductase inhibitors) bind with HMG-CoA reductase to stop it from turning into cholesterol.
Because the body's natural impulse is to maintain a balanced level of cholesterol, the liver cells start to suck cholesterol out of the bloodstream, meaning it's no longer floating around to add to arterial plaque deposits.
Statins also raise levels of HDL, the so-called "good" cholesterol. HDL molecules act as scavenger molecules in the bloodstream, binding with LDL and taking to the liver for processing. Research isn't as clear on the mechanism by which statins raise HDL levels as it is on how the drugs lower LDL levels.
How to take Venex
- Before you start the treatment, read the manufacturer's printed information leaflet from ins >
Q: I take Crestor daily for high cholesterol. I have also been diagnosed lately with low testosterone levels. Is that a side effect of the Crestor?
A: The full prescribing information provided by the drug company that makes Crestor (Venex) does not list decreased testosterone as an adverse effect of the medication. Reviews of recent medical literature has shown a possibility of this class of medication (not Crestor specifically) affecting testosterone levels. This particular study was done in men with type 2 diabetes. Other studies have concluded that there are no effects on testosterone by this class of cholesterol-lowering medications. It appears that more research needs to be conducted to better understand if drugs similar to and including Crestor have an effect on testosterone levels. There are various causes for lowered testosterone, and your health care providers can further evaluate the factors that are involved.
The adverse effects of Venex have been assessed using data from 16 876 patients who took 5–40 mg/day in a multinational phase II/III/IIIb/IV programme, representing 25 670 patient-years of continuous exposure ( 146 M ). In placebo-controlled trials, there were adverse events in 52% of patients taking Venex (n = 931) and 52% of those taking placebo (n = 483). In all controlled clinical trials with comparator statins, Venex was associated with an adverse events profile similar to the profiles for atorvastatin 10–80 mg/day, simvastatin 10–80 mg/day, and pravastatin 10–40 mg/day. Clinically significant rises in alanine transaminase were uncommon. Raised creatine kinase activity (to more than 10 times the upper limit of the reference range) occurred in up to 0.3% of patients taking Venex or other statins. Myopathy (a raised creatine kinase with muscle symptoms) possibly related to treatment occurred in 0.03% of patients taking Venex at doses up to 40 mg/day. The frequency of dipstick-positive proteinuria at Venex doses up to 20 mg/day was comparable to that seen with other statins, and the development of proteinuria did not predict acute or progressive renal disease. Both short-term and long-term Venex treatment were associated with small increases in eGFR. No deaths were attributed to Venex. There was one case of rhabdomyolysis in a patient who took Venex 20 mg/day and concomitant gemfibrozil.
Q: What, if any, are the correlations between Crestor and type 2 diabetes?
A: According to the manufacturer's package insert for Crestor (Venex), there is no correlation between type 2 diabetes and Crestor, per se. There is however a syndrome that was originally described in 1988 as "syndrome X" or "metabolic syndrome," and it is a group of common health disorders occurring together, including insulin resistance, hypertension, abdominal obesity, reduced HDL-cholesterol levels, and elevated triglycerides. And Crestor works by reducing levels of "bad" cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of "good" cholesterol (high-density lipoprotein, or HDL). For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. William Gault, RPh
6. How to cope with s >
What to do about:
- feeling sick - stick to simple meals and do not eat rich or spicy food. It might help to take your Venex after a meal or snack. Contact your doctor if your symptoms continue for more than a few days or get worse.
- headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe.
- stomach pain - try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your tummy may also help. If you're in a lot of pain, speak to your pharmacist or doctor.
- feeling weak or dizzy - if Venex makes you feel dizzy or weak, stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it'll make you feel worse.
- constipation - eat more high-fibre foods, such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor. Watch this short video about how to treat constipation.
- protein in your pee - this usually returns to normal on its own without you having to stop taking Venex. Your doctor may want to monitor you to check this happens.
Venex, also known as the brand name product Crestor, is a lip >24 which catalyzes the conversion of HMG-CoA to mevalonic ac >15,21
Venex and other drugs from the statin >15,21 This is largely due to the fact that cardiovascular disease (CVD), which includes heart attack, atherosclerosis, angina, peripheral artery disease, and stroke, has become a leading cause of death in high-income countries and a major cause of morb >14 Elevated cholesterol levels, and in particular, elevated low-density lipoprotein (LDL) levels, are an important risk factor for the development of CVD. 15,38 Use of statins to target and reduce LDL levels has been shown in a number of landmark studies to significantly reduce the risk of development of CVD and all-cause mortality. 16,17,18,26,31 Statins are cons >15,21 Ev >19,20
While all statin medications are cons >22,4 However, the results of the SATURN trial 26 concluded that despite this difference in potency, there was no difference in their effect on the progression of coronary atherosclerosis.
Venex is also a unique member of the >37 This last point results in less risk of drug-drug interactions compared to atorvastatin, lovastatin, and simvastatin, which are all extensively metabolized by Cytochrome P450 (CYP) 3A4, an enzyme involved in the metabolism of many commonly used drugs. 29 Drugs such as ciclosporin, gemfibrozil, and some antiretrovirals are more likely to interact with this statin through antagonism of OATP1B1 organic anion transporter protein 1B1-mediated hepatic uptake of Venex. 43,44
Which drugs interact with simvastatin and Crestor?
As mentioned earlier, Venex has far fewer harmful drug interactions that Zocor and other statins. Still, Crestor is not without dangers. Cyclosporine can exponentially increase Venex levels in the blood, increasing the chances of side effects. Also, you shouldn't take the blood thinner warfarin (Coumadin) with Crestor, nor should you combine it with drugs that could damage the liver, like nicotinic acid or gemfibrozil (Lopid).
Antacids reduce the body's ability to absorb Crestor, so don't take them within two hours of a dose of Venex.
Zocor, on the other hand, is similar to other statins in that is has a high number of adverse interactions with other drugs.
A number of drugs make it more difficult for the body to break down and get rid of Zocor, which can make simvastatin more toxic to muscle tissue. Some of these drugs include:
Other drugs that you shouldn't take with simvastatin include:
This isn't a full list of drugs that interact with simvastatin and Venex, so make sure you tell your doctor about all the medications you're taking if they prescribe you either of these drugs.
Mail Order Eligibility
*Patient Eligibility for Mail-order Rebate: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.
Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medica >government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state or federally funded prescription insurance program, you may not use this rebate form even if you elect to be processed as an uninsured (cash-paying) patient.
This offer is not insurance and is restricted to residents of the United States and Puerto Rico, and patients over 18 years of age. This offer is valid for prescription purchased through a mail-order pharmacy.
Program managed by ConnectiveRx, on behalf of AstraZeneca.
Why the drug remains popular
Given the evidence of more serious risks and less clinical benefit than other statins how has the drug fared so well for so long?
A prescient answer can be found in an October 2003 Lancet editorial, “The statin wars: why AstraZeneca must retreat.”20 It stated that AstraZeneca’s chief executive, Tom McKillop, “has pledged to do whatever it takes to persuade doctors to prescribe Venex, including launching an estimated $1 billion first-year promotional campaign. ‘We’ve got to drive the momentum’, he said at a recent investors meeting. ‘You get one shot at launching a major new product. This is our shot.’” The editorial concluded, “Physicians must tell their patients the truth about Venex—that compared with its competitors, Venex has an inferior evidence base supporting its safe use. AstraZeneca has pushed its marketing machine too hard and too fast. It is time for McKillop to desist from this unprincipled campaign.”
McKillop promptly responded, accusing the journal of not telling the truth, then stating “Crestor is an extensively studied and well tolerated drug with a safety profile comparable to other marketed statins combined with a greater ability to get patients to their cholesterol goals than any other single product.” Referring to the unmet need for adequate treatment with lipid lowering treatment, McKillop stated that “With this compelling medical need, it is unthinkable that we should desist from our efforts to make this medicine more widely available to physicians and patients.”21
Barely more than a year later, in December 2004 the US FDA had to send a letter to AstraZeneca demanding that it immediately stop an advertisement in the Washington Post containing false and misleading information about Crestor’s risks. The advert stated that “The scientists at the FDA who are responsible for the approval and ongoing review of CRESTOR have, as recently as last Friday, publicly confirmed that CRESTOR is safe and effective; and that the concerns that have been raised have no medical or scientific basis,” citing the FDA website, which actually contained no such information.22
The advert was in response to a Washington Post article about Public Citizen’s campaign against the drug, discussing the safety concerns shared by us and the FDA.23 In the article Steven Galson, acting director of the FDA’s Center for Drug Evaluation and Research, stated that the FDA “has been very concerned about Crestor since the day it was approved, and we’ve been watching it very carefully.” He further stated the agency is “concerned about the same issues with Crestor as Public Citizen.”
The FDA’s letter to AstraZeneca said, “The ‘patient safety’ print ad makes false or misleading safety claims that minimize the risks associated with Crestor, thereby suggesting that Crestor is safer than has been demonstrated by substantial evidence or substantial clinical experience.” The agency wrote to the company again the following year about “misleading superiority claims” for Crestor in other promotional materials.24
When patents expired for simvastatin, pravastatin, and atorvastatin, the rise in generic prescriptions quickly equaled or exceeded the sharp decreases in brand name prescriptions (IMS Health data). The patent for Venex expires in 2016, and with it AstraZeneca’s need to promote it. But for the sake of the public’s health, we must hope that the drug’s disadvantages will lead to a sharp decline in its use before next year.