Atorvastatin 20 mg evening + ezetimibe 10 mg, ApoB tracked (20 wks update): Background: Female, 57, hyperlipidemia and hypertension on amlodipine 5 mg — what worked for others here?
Background: Female, 57, hyperlipidemia and hypertension on amlodipine 5 mg. Atorvastatin 80 mg caused diffuse achiness and fatigue, with LDL-C of 64 mg/dL and ApoB of 82 mg/dL. Protocol: I lowered atorvastatin to 20 mg and added ezetimibe 10 mg, both with dinner. I took omega-3 only after triglycerides were rechecked, and I kept vitamin D3 at 1,000 IU because my 25-OH D was 31 ng/mL. I walked 30 minutes 5 days a week and added soluble fiber at 10 g daily. Results at week 20: aching 1/10, LDL-C 55 mg/dL, ApoB 66 mg/dL, triglycerides 118 mg/dL, home BP averaging 126/78. Takeaway: tracking ApoB, not LDL-C alone, showed the lower statin dose plus ezetimibe was working. Discuss any change with your prescriber.
FDA DailyMed labeling for atorvastatin notes a half-life of about 14 hours, with active metabolites acting 20-30 hours, so dosing time of day is flexible. In IMPROVE-IT (NEJM 2015), adding ezetimibe to simvastatin produced a 6.4% relative risk reduction in the primary composite endpoint.