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September 13, 2007

Other Medications

Question from Greenbelt, Maryland, USA:

My son has high cholesterol so his endocrinologist wants to give him Lipitor. Has there been long term research on the effects of Lipitor? Is it safe for him to take it at the age of 11?

Answer:

Lipitor (atorvastatin) is one of several medicines in a family of medicines referred to as “statins.” They inhibit an important enzyme in the manufacturing of cholesterol in the liver. They are generally very good about lowering cholesterol, especially the “bad” LDL cholesterol.

Most situations of high cholesterol more reflect your genetic capacity to make cholesterol rather than your diet. Nevertheless, diet and exercise play important roles in lowering cholesterol. There is some science also about the cholesterol lowering effects of eating oats (in large quantities); there is some science about the cholesterol lowering effects of eating some fruits that have red peels (e.g., red grapes, red plums, possibly cherries, maybe others). There are new investigations exploring the potential cholesterol lowering effects of “red yeast rice” which apparently is a Chinese supplement. There is some evidence that this material MAY contain a chemical similar to the statins.

So, having said that, unless the cholesterol profile is really, really high, one would expect to start the 11-year-old on diet and lifestyle changes before adding a statin. Your letter didn’t denote how well controlled his diabetes is, but this would be important. You would also want to be sure that the thyroid levels are normal.

There are now published protocols for children outlining those at higher risk of elevated cholesterol (“hypercholesterolemia”) and then giving treatment goals. So, the presence of diabetes, presence of worrisome family history, large weight, and others would influence now when to start with a statin.

Some older statins are approved in children as young as eight. Lipitor, last I checked, was approved for children as young as 10. Long term effects in children? They are not really known because this medicine has not been used in children for 30 or more years to see what might happen in the distant future. But, of course, we have adults on this medicine. The more common ill-effects in children and adults seem to be on liver function. But, this is really not so very common. Nevertheless, periodic measurement of liver functions in routine blood work is warranted. There can be RARE, but SERIOUS side effects of muscle deterioration (characterized by diffuse, muscle pain), but this has mostly been associated when used with other lipid lowering drugs.

There does not seem to be effects upon fertility in males or females. However, females of child-bearing age should NOT use statins (unless they abstain from sex or use oral contraceptives) because statins can cause birth defects in the developing fetus.

So, you should get a better understanding from your doctor just how high the cholesterol levels are, the various risk factors, the genuine attempts at lifestyle and diet changes, and weigh the enormous potential benefit from statins compared to any risks.

DS