Tuesday, January 15, 2008

Should I Stop Taking Zetia?

After Merck & Co. and Schering-Plough Corp. admitted that Vytorin -- a combination of Zetia and Zocor (simvastatin) -- worked no better than an older, generic medication to reduce plaques in arteries, Dr. Steven Nissen, head of cardiology at the Cleveland Clinic in Ohio, immediately called for a "moratorium" on the use of Vytorin and Zetia, according to a story on Bloomberg.com (see coverage here).

My question is this: Should I stop taking Zetia, which was prescribed to me by my cardiologist, who--although I respect his judgment--is no head of cardiology at a renowned medical center?

The problem is that I haven't heard from MY CARDIOLOGIST or MY FAMILY DOCTOR about whether or not I should continue to take Zetia. I guess I should call them.

But why is it that the my Volkswagen service center calls me soon after buying a new car, whereas I have never received a call from any doctor about service for my body?

I know that Nissen is not my doctor and is not giving individual medical advice to all those patients like me out there who are on Zetia or Vytorin and whose doctors are mum on the subject. Whether or not I should continue my medication depends upon my personal medical history that only me and my doctor can evaluate.

But where is my doctor? Why isn't he more pro-active? Why hasn't he contacted me a long time ago and either re-assured me about Zetia or told me to hold off until the ENHANCE study data were reported? Why didn't he tell me about the study a long time ago and what it might mean for ME personally? I know you will say that he should have and I should find a doctor who is more proactive. Hey, it may be possible to find one. But who has the time for all that due diligence and switching medical records around!

There's all kinds of cardiologists these days advising me what to do. There's Dr. Jarvik, for example. He's telling me that Lipitor is good for my cholesterol. Oh! Wait a minute! He's not REALLY a cardiologist. In fact, he doesn't even have a license to practice medicine at all (see Jarvik -- Lipitor spokesperson -- "outed" as an unlicensed physician!).

Then there's Dr. Nissen, who IS a practicing cardiologist. He's quoted all the time in the media. I respect his opinion although I know he's every pharmaceutical executive's worst nightmare.

I am sure there will be many more cardiologists weighing in with their opinions in media stories to come. But MY doctor probably won't be one of them.

Of course, I will be calling my cardiologist today and asking him about all this. I will report back to you when I hear something from him.

P.S. Don't worry about me. While my cholesterol is a bit high, I have recently passed my high-tech stress test, which cost my insurance company about $13,000 (thanks be to God that my wife has a real job with good benefits. My laid-off neighbor with 2 small children, however, is not so lucky.)

P.P.S. Since this blog is really all about pharmaceutical marketing, I should say something about how the ENHANCE trial failure may affect the advertising of Zetia and Vytorin.

Obviously, these brands are probably maintaining a low profile these days. I don't remember seeing the usual ads on TV last night. Perhaps the ads are being revamped in light of the ENHANCE trial news and will soon re-appear addressing the issues raised by the study's failure. But why weren't these damage-control ads rolled out IMMEDIATELY? Maybe it's best to say nothing to the public -- No way! Merck and Schering-Plough should have PSAs explaining their take on the situation and NOT just depend on issuing a press release!

What about the product web sites? Perhaps they have some information. I checked both www.zetia.com and www.vytorin.com -- both the patient and doctor sites -- and found NOTHING about the recent news. I looked in patient education areas where doctors are supposed to find information to hand out to their patients, I looked in the FAQ areas, the "Questions to Ask Your Doctor" areas, the "Studies" areas -- NO WHERE COULD I FIND A WORD ABOUT THIS!

That's a shame in my book. Shame on you Merck! Shame on you Schering-Plough! Shame on you MY DOCTOR!

Then they wonder why patients go to other sources on the Internet and other patients they do not even know on the Internet to find information they need about their medications!


  1. Anonymous9:47 AM

    I'm not a doctor, but I see no reason why you should take ezetimibe. Statins have been shown to prevent heart attacks and strokes. Ezetimibe hasn't. It's a no-brainer, unless you cannot take statins for some reason. Why did your doctor prescribe ezetimibe instead of a statin in the first place? Or was the ezetimibe an add-on to a statin? If the latter, and you or your doctor feel your LDL is too high on your current statin dose, you could increase the dose of the statin or try a more potent one.

  2. I was taking a statin in addition to Zetia, but stopped because I felt the statin was having an effect on me.

  3. Anonymous12:27 PM

    Consider this: Zetia.com is unusually progressive among brand.com sites in one respect -- it has an RSS feed. Hey! Maybe they're using this to inform concerned patients and public about emerging Zetia info?!?! Nope. All you get are pushed links to the self-assessment quiz, the doctor-talk tips, and other usual boilerplate. Damn! They've got the right tool already in place, and they're wasting it.

  4. Simply wonderful post, John.

  5. Anonymous2:37 PM

    Hey John,

    I think the lesson here is that cholesterol itself has nothing to do with heart disease.

    So, if you know you have heart disease, a statin might improve your odds of survival a bit, but not at all because they lower cholesterol. That's just a side effect of their anti-inflammation properties.

    But Zetia has never been shown, and has still not been shown, to improve any clinical condition except high cholesterol, which, as I said is irrelevant to heart disease.

    So, what you should be considering is dropping ALL cholesterol medicine unless you know you have heart disease. If so, take a low dose of a cheap statin, and don't worry about your cholesterol numbers!

    This is my opinion, and it is also what I do for myself.

    Hope you find your way--

    Art D.

  6. Anonymous12:28 PM

    Believe it or not, you don't need statins at all to dramatically lower your cholesterol. It's like thinking you need aspartame soda to quench your thirst - brainwashing. I lowered mine accidentally to below normal using an herbal tea and high dose vitamin C. It's documented in a physical from years ago. Fiber, soy sterols, niacin, vitamin C, omega-3 all still work. They didn't stop working just because statins came out. It's a question of dose, which these "brilliant" scientists never use enough of in their "double-blind placebo controlled" studies using a few mg this or few mg that. If it's a question of money, billions of dollars can be made in selling herbs and vitamins.

  7. Anonymous12:54 PM

    Why am I spending money on something that does me no good. I can not take statins but eat right, exercise and am a normal weight. I also take 6000 mg of fish oil, vitimins, soy. Is this enough for me? My good cholestrol id 81 and my bad is 155. Any thoughts?

  8. Anonymous4:06 PM

    My dr. never told me to try exercise or change my diet before prescribing Zeti. It is very expensive!! I would like to get off it and try other options. Can I just stop taking it or will it cause any problems?

    1. I suggest you ask your doctor. I'm no doctor, but in my opinion, I don't think it will matter much on or off.


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