Yesterday I had a gentleman come into the pharmacy with a new prescription for rosuvastatin 40mg to treat high cholesterol. Knowing that he has been taking paroxetine for some time I quickly had a look at the paroxetine monograph in the interactions section. Low and behold, paroxetine has been shown to increase cholesterol levels in patients.
From the product monograph:
“ Serum Cholesterol Elevation
Several public domain studies have shown increased LDL-cholesterol levels of ~10% in volunteers and patients taking paroxetine for 8 to 12 weeks, which generally normalized after paroxetine discontinuation. In addition, of the patients in placebo-controlled clinical trials for whom baseline and on-treatment measurements were taken, total serum levels of cholesterol showed a mean increase of ~1.5 mg/dL in paroxetine-treated patients (n=653), compared to a mean decrease of ~5.0 mg/dL in placebo-treated patients (n=379). Increases from baseline of 45 mg/dL or greater were recorded in 6.6% of paroxetine-treated patients compared to 2.6% of placebo-treated patients (see Monitoring and Laboratory Tests, Serum Cholesterol Elevation).”
I informed the patient about the interaction and let him decide if he wanted to start the statin or discuss alternatives to paroxetine with his doctor before adding this medication to his regimen. The patient explained that since it had been a long road to finding an effective antidepressant, he would start the statin. I faxed the physician and let him know of the interaction. Now the patient, myself and the physician are all aware that while he is at an age where high cholesterol begins to be a problem, his other medication may be contributing to his levels as well. We will all be in a position to help counsel him on his cholesterol management from a more understanding and informed perspective.
This case study highlights the importance of a functional medicine approach to new prescriptions. One of the worst features of our current medical system is the treatment of medication side effects with additional medication. As drug experts, pharmacists are the ideal professional to identify and rectify this problem saving patients and the healthcare system time and money.
Also highlighted here is the importance of a true community pharmacist able to take care of patients with care and attention. With the recent cutbacks to pharmacy, we’re seeing more and more pharmacists being asked to do more with less. As a pharmacist in an independent pharmacy I had the time to catch this and take the appropriate actions, but for the majority of the pharmacists out there this is unfortunately not the case.
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