Doctor's Decisions on Cholesterol Medication Adjustments

Q: Doctor's Decisions on Cholesterol Medication Adjustments

Hello： <br>1. <br>Normal fasting blood glucose levels are between 70-100 mg/dL. <br>Levels that are too low may indicate hypothyroidism or galactosemia. <br>Temporary causes can include alcohol consumption, severe liver disease, starvation, and certain medications (such as antitu

I would like to understand issues related to medication prescribed by doctors?

Hello Doctor, I would like to ask about my lipid-lowering medication.
I have been taking it for a while, and my last blood test results were as follows: the dosage is 10 mg taken every two days, with AST (aspartate aminotransferase) at 24, fasting blood glucose at 84, triglycerides at 48, HDL-C (high-density lipoprotein cholesterol) at 56, and LDL-C (low-density lipoprotein cholesterol) at 111.4.
This time, my follow-up results showed triglycerides at 122 and LDL-C at 108.9.
The doctor has adjusted my medication to 10 mg taken every three days.

(1) Based on the above data, does the National Health Insurance Administration require a dosage reduction, or is it up to the doctor's discretion to decide whether to reduce the medication?
(2) Are lipid-lowering medications considered controlled substances? Thank you!

Xiao, 30~39 year old female. Ask Date: 2016/03/15

Dr. Hou Fangmin reply Pharmacology

Hello:
1.
Normal fasting blood glucose levels are between 70-100 mg/dL.
Levels that are too low may indicate hypothyroidism or galactosemia.
Temporary causes can include alcohol consumption, severe liver disease, starvation, and certain medications (such as antituberculosis drugs).
High levels may indicate diabetes or hyperthyroidism.

Cholesterol (CHOL) normal values are between 0-199 mg/dL.
Low levels may indicate malnutrition, cirrhosis, anemia, or uremia.
High levels may indicate familial hypercholesterolemia, diabetes, hypothyroidism, atherosclerosis, late pregnancy, or postmenopausal status.

Low-density lipoprotein (LDL) normal values are between 0-100 mg/dL.
Low levels may indicate congenital absence of this protein, malnutrition, hyperthyroidism, anemia, or uremia.
High levels may indicate familial hyperlipidemia, hypothyroidism, diabetes, renal failure, pregnancy, or medications (such as estrogen or testosterone).

Triglycerides (TG) normal values are between 0-199 mg/dL.
Low levels may indicate malnutrition.
High levels may indicate familial conditions, kidney disease, liver disease, diabetes, hypothyroidism, or pregnancy.

Alanine aminotransferase (ALT or GPT) and aspartate aminotransferase (AST or GOT) are enzymes found in the liver, skeletal muscle, brain, red blood cells, and cardiac cells.
When these tissues are damaged, these enzymes are released into the bloodstream.
Normal values for ALT (GPT) are between 7-35 U/L and for AST (GOT) are between 15-41 U/L.

Low levels may indicate pyridoxine (B6) deficiency.

High levels:
1.
>20 times the normal upper limit may indicate viral hepatitis (ALT > AST).

2.
Moderate increase (>3-10 times) may indicate chronic active hepatitis (AST > ALT), biliary obstruction (ALT > AST), or myocardial infarction (AST > ALT).

3.
Mild increase (>1-3 times) may indicate cirrhosis (AST > ALT), acute hepatitis (ALT > AST), hepatocellular necrosis or damage, alcoholic hepatitis and cirrhosis (AST > ALT), liver cancer, heart failure, myocardial or skeletal muscle injury or necrosis, myocardial infarction (AST > ALT), ischemia, or hypoxia.

The above information pertains to your laboratory test results.
At 30 years of age, your current test results are normal.
If you have been on medication for a long time to lower these levels, your physician may need to adjust your dosage.
For patients with cardiovascular disease or diabetes, the health insurance guidelines state that triglycerides should be <160 mg/dL and LDL-C <100 mg/dL.
Therefore, your physician will adjust your medication based on clinical findings and your data.
However, it is still recommended that exercise is the best remedy for high lipid levels.

2.
Are lipid-lowering medications controlled substances? They are not controlled substances.

Wishing you good health and well-being.

Reply Date: 2016/03/15

More Info

When discussing cholesterol medication adjustments with your doctor, it's essential to understand both the clinical guidelines and the individual factors that influence treatment decisions. Based on the information you've provided, it seems you have been on a lipid-lowering medication, and your doctor has adjusted your dosage based on your recent lab results. Let's break down your questions and provide some clarity.

1. Medication Adjustment and Guidelines: The decision to adjust medication dosages, including lipid-lowering agents, is primarily made by the physician based on clinical judgment, patient-specific factors, and established guidelines. While health insurance regulations may influence treatment protocols, they do not dictate specific medication adjustments. In your case, the increase in triglycerides and slight decrease in LDL-C levels from your previous tests may have prompted your doctor to consider a reduction in dosage. This is a common practice to minimize potential side effects while still managing cholesterol levels effectively. Your doctor may also consider other factors such as your overall health, risk factors for cardiovascular disease, and any side effects you may be experiencing from the medication.

2. Controlled Substances: Most lipid-lowering medications, such as statins, are not classified as controlled substances. Controlled substances are drugs that have a higher potential for abuse and dependence, which is not typically the case with cholesterol medications. Statins, for example, are widely prescribed and considered safe for long-term use in managing cholesterol levels. However, like any medication, they can have side effects, and monitoring is essential to ensure they are working effectively without causing harm.

Additional Considerations
When discussing medication adjustments with your doctor, consider the following points:
- Understanding Your Lab Results: It's crucial to understand what your lipid panel results mean. For instance, while your LDL-C levels are slightly elevated, your HDL-C (good cholesterol) is within a reasonable range, and your triglycerides have increased. Your doctor will interpret these results in the context of your overall health and risk factors.

- Lifestyle Factors: In addition to medication, lifestyle changes such as diet, exercise, and weight management play a significant role in managing cholesterol levels. Discussing these factors with your doctor can provide a more comprehensive approach to your treatment.

- Side Effects and Concerns: If you have concerns about side effects from your current medication, be sure to communicate these with your doctor. They may consider alternative medications or additional therapies to help manage your cholesterol without compromising your quality of life.

- Regular Monitoring: Regular follow-up appointments and lab tests are essential to monitor your cholesterol levels and assess the effectiveness of your treatment plan. This ongoing evaluation allows for timely adjustments based on your response to therapy.

In conclusion, while health insurance regulations may influence treatment protocols, the decision to adjust cholesterol medication is ultimately made by your physician based on clinical judgment and patient-specific factors. Lipid-lowering medications are generally not classified as controlled substances, and ongoing communication with your healthcare provider is vital for effective management of your cholesterol levels. Always feel empowered to ask questions and express any concerns you may have regarding your treatment plan.

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