Q: My colleague has high cholesterol (270), LDL (200) and triglycerides (174). He was prescribed Atorec 10 mg. Despite the use of the medicine for 5 months, the lipid profile did not improve. He consulted another internist who put him on Rosucor 10 and after 2 months, all the above numbers reduced drastically to half. What is this medicine? Is this more effective than Atorec?

A:Atorec is the brand name of an anti-cholesterol medicine called atorvastatin. Rosucor is the brand name of rosuvastatin. The mechanism of action of both atorvastatin and rosuvastatin (called statins ) is identical. However the usual dose of atorvastatin is 10mg daily while the maximum allowed is 80mg daily (range 10-80mg). On the other hand the usual dose of rosuvastatin is 5mg and usual maximum is 10mg (range 5-10mg). In exceptional cases, it is allowed to be increased to 20mg (maximum range 5-20mg). Thus atorvastatin (Atorec) at 10mg dose is much less than rosuvastatin (Rosucor) 10mg. The correct clinical course of action would have been to increase the dose of atorvastatin to 20mg if not 40mg. There is an additional issue. As per data submitted to the U. S. Food and Drug Administration (USFDA), the metabolic behaviour of rosuvastatin is ethnic-sensitive with blood levels reaching higher levels in certain populations such as Asians compared to Caucasians. This can lead to more severe side effects such as life-threatening rhabdomyolysis. Because of these findings, the innovator company has been asked to generate more data on ethnic populations at risk (such as Asians) apart from marketing a lower dose 5mg tablet. Western drug regulators have also made it obligatory that prescribers inform all patients that Rosuvastatin can cause muscle injury, which in severe cases can cause kidney damage and other organ failure that are potentially life-threatening. Hence patients must promptly report signs and symptoms of muscle pain and weakness, malaise, fever, dark urine, nausea or vomiting to their doctors.