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In the US version, the manufacturer states to discard the pen 56 days after first use. It’s too bad because you are right; if you dial down then there’s still medication left.

Great question! Historically, patients were treated according to their cholesterol level: high cholesterol = statin. Several years ago, the guidelines changed. Now, patients are started on a statin if their 10-year cardiovascular disease (CVD) event risk is 10% or greater and at least one CVD risk factor. One example of an “event” would be a heart attack. Some doctors also prescribe a statin if the event risk is 7.5% or greater. This is regardless of cholesterol number. This has resulted in patients with normal cholesterol to be placed on statins. In fact, the majority of patients with diabetes are placed on statins. In addition, a few patients with elevated cholesterol and no risk factors were taken off statins due to lack of risk factors.

Yes, that is true. The main difference between a menstrual period and withdrawal bleeding is that a menstrual period involves the release of an egg, while withdrawal bleeding does not. Withdrawal bleeding occurs when the synthetic hormones in birth control stop, causing the uterine lining to shed, but no egg is released. Your question about if periods that occur on Opill are real periods or withdrawal bleeding is actually a great question. Here is what we know: Opill does suppress ovulation in some women (about half) and its unpredictable. That is why it is not considered the mechanism of how it prevents pregnancy. We also know, that about half of women taking progestin-only birth control pills get periods. Since there is no withdrawal of the hormone (assuming the woman is taking it every day without fail), then it is likely that periods that occur in women taking Opill are true periods and not withdrawal bleeding. This is true for the 2 most common progestin-only birth control pills in the US which contain Norethindrone (prescription) and Norgestrel (Opill). A different one called Slynd (contains Drospirenone) and a UK one called Lovima (contains Desogestrel), do suppress ovulation as part of their main mechanism of birth control.

A fellow pharmacist! Welcome! I fully believe that our brain needs a healthy amount of cholesterol and in my opinion, it is detrimental to be too high or too low. As it relates to statins, I would like to ask: Are you taking a statin? Which one and the dose? What was your baseline cholesterol prior to starting the statin? How long have you been on your statin? There is also a rare side effect that can occur with statins that is brain fog, and it is reversible after stopping the statin. Your early onset dementia may or may not be related to your statin, so I want to point you in another direction. Have you heard of something called “Type 3 Diabetes”? There is emerging research about dementia sometimes being caused by insulin resistance in the brain resulting in the brain gradually being less and less able to use glucose. The emerging research is showing that in these situations, the brain can still use ketones and there have now been cases where dementia has improved with taking coconut oil, perhaps because it has lots of “medium chain triglycerides” (MCT’s). This is not my area of expertise and does not involve medications. However, if you look this up, you will find many people have had success. This is a video interview with Dr Mary Newport and she shares the story of her husband with early onset dementia: th-cam.com/video/r3-5GQfeJ68/w-d-xo.htmlsi=tjr9lj5aC2PPdsnN She also has other interviews online and a Tedx. I highly encourage you to check into this. Please update me and good health to you!💕

Thank you! I wasn’t aware of this. I will check it out!

I definitely don’t want you to have either.

Thank you for sharing with everyone. Best of luck to you!

I promise you, this video is definitely not a commercial. Although, now that you mentioned this, I can see how it would look like it. I’m a real pharmacist working at a pharmacy. I have no affiliation with any pharmaceutical company and they don’t even know I exist. This was the 2nd video I made and I was trying to model it after other videos I saw. Being a pharmacist over many years, I have seen patients struggle to get to a healthy weight and I have been truly amazed by Mounjaro/Zepbound. When Mounjaro came out, my diabetic patients started dropping weight and I got excited when they released it under Zepbound so non- diabetics could use it too. That’s why I made the video. So it’s not just me getting all the Vshred ads!

Unfortunately, rosuvastatin has side effects like other statins - especially when the dose is above 5mg. Rosuvastatin is the most potent of all statins and for many people it really should be kept at 5mg. The vast majority of benefit is seen at this lowest dose and only a small amount of additional benefit is added with each dose escalation - but lots of side effects as the dose gets higher. You should not have to live with those side effects! Please talk to your doctor about it. If you are on a dose higher than 5mg, you can ask if you are a candidate for a lower dose. Another option is asking your doctor if you can try pravastatin. It the very best tolerated statin and I’ve only had 1 patient that had side effects with it. If you have elevated baseline cholesterol, it would be fine to try atorvastatin as well.

My most honest answer is “true” and “true.” Statistics are tricky and can be presented in a way that can be misleading or overstated / understated. Additionally, it is absolutely true that many studies show an association with statins and decreased risk of dementia. That is why the results of this study are surprising to me and why I made the video. The difference between this study and others are that people with low or normal baseline cholesterol are pulled out and looked at specifically in addition to looking at the lipophilicity of their statin. Up until recently, people with low or normal baseline cholesterol did not get prescribed a statin. This is a fairly new guideline. It is still uncommon but does happen and I personally know some of these patients. According to the guidelines, the patient would be prescribed the statin if they have a CV risk factor, such as diabetes. Although we don’t know why this association exists, we understand from many studies that very elevated cholesterol is associated with an increased risk of dementia and statins lower risk of dementia in this more common situation. Now it seems that low or normal baseline cholesterol plus certain statins are associated with a higher risk of cognitive impairment/ dementia. It appears that both very high and very low cholesterol levels in the brain are unhealthy. There is no proof of this yet, but I believe we should act on what we know as long as no harm is done. High baseline cholesterol + CV risk =any statin is fine. Low/ normal baseline cholesterol + CV risk = rosuvastatin or pravastatin. This is my opinion after deep diving this subject and reading many studies. Let’s go forward cautiously and first, do no harm. Thank you for your important comment.

Venlafaxine should not interfere with Wegovy and it is not a medication that is associated with weight gain. In fact, a small percentage of people actually lose some weight from venlafaxine so it’s unlikely to be interfering. If you were on Ozempic for only 2 months, I imagine that you probably only got to the 0.5mg dose. I am wondering if your doctor started the Wegovy at the next dose up (1mg) or did you start over with a starter dose again? Ozempic and Wegovy contain the identical ingredient: semaglutide. One possible reason for a stall in weight loss is the dose being too low. Since you are starting to feel hungry again since you switched over to Wegovy, it sounds like you may have started the titration over again. Here is another possible reason, but less likely with the information you provided: when we start losing weight because we are consuming less calories, our body starts using stored glycogen. Glycogen is stored with water. The water gets released from the body as glycogen stores get utilized which can result in many pounds of water weight being lost within the first couple of weeks. Then, the weight loss stalls because it actually takes longer to gradually lose fat. Hopefully your doctor talked to you about getting the proper amount of protein and also about being active. If we don’t take in enough protein when we calorie restrict, the body may pull protein from your muscle (instead of fat). If the weight continues to stall and your appetite does not decrease, you can talk to your doctor about switching to tirzepatide (Zepbound / Mounjaro). It is associated with more weight loss vs semaglutide (Wegovy / Ozempic). Definitely don’t give up! Even if you end up losing only 5% of your body weight, you will experience clinically significant health benefits. Best of luck to you!

Welcome to my channel! Hopefully the US products are the same as Canadian ones. For us, the 2mg/3ml pen is in a red box and dials a max dose of 0.5mg. If that is same in Canada, then it is 17 or 18 clicks to get approximately 0.12mg. It makes sense to go slow if you are not tolerating it. However, please let your doctor know you are slowing it down so they are on the same page. Best of luck to you!

@@veena-usa Yes the box is the same! I was nervous about making a mistake in the clicks but you reassured me. I will not fail to discuss it with my doctor at my next appointment. I subscribed! A big thank you! 😊

You are very welcome!

For Wegovy, Zepbound and other weekly GLP-1’s, you would typically titrate up to the next dose every 4 weeks. Doctors usually have their patients check in each month to see if they are tolerating it prior to advancing the dose. When side effects like nausea are continuing throughout the month, doctors typically pause the upward titration and keep the patient on the same dose for another 4 weeks. If you are already on a medication like Wegovy, just make sure to check in with your doctor each month during the titration so they know if you are ready to advance. Best of luck to you!

It would be 18 clicks to dial approximately 0.125mg on a starter dose pen (red and white box). This is the pen that dials 0.25mg and also max dose of 0.5mg. Please make sure your doctor knows you are dialing down. It could cause your glucose to be less controlled if you are taking it for diabetes. Best of luck to you!

@@veena-usa appreciated

The relative risk reduction is about 30% and the absolute risk reduction is about 1.3% depending on the study. Thank you for the suggestion! This topic is important as well as NNT. Many people feel the benefits of some medications are overstated because they are reported as relative risk.

@@veena-usa Yes. The general public hears the advertised relative risk and automatically assumes they reduce their risk of an event by 30%. The math is elementary. However grasping the concept of the difference may not click for many. That's why I have been developing a way to explain it so a 7th grader will clearly understand.

Your welcome!

I’m so glad it reaching the right people!

Yes, 36 or 37 clicks are both approximately a 1mg dose if using a pen that dials max 2mg (gold and white box). If you are a patient asking, please make sure to talk to your doctor before dialing down. If you are using it for diabetes, it may cause your glucose to be less controlled. Best of luck to you!

Unfortunately, the Wegovy pens don’t allow you to adjust the dose. They are auto injectors and will automatically inject the entire dose. If you can talk to your doctor about your desire to be on a smaller dose, they can prescribe the Ozempic pen (same ingredient as Wegovy) and you can adjust the dose. One problem that may occur is that your insurance may not cover Ozempic if you do not have type 2 diabetes. Despite being the same ingredient, the Ozempic device is used for diabetes and the Wegovy device is used for weight management.

I have heard of it in terms of being used for pain and inflammation. I was not aware that it had any potential benefit for vascular inflammation. The animal study you mention sounds interesting. Thank you!

Historically, patients were treated according to their cholesterol level: high cholesterol = statin. Several years ago, the guidelines changed. Now, patients are started on a statin if their 10-year cardiovascular disease (CVD) event risk is 10% or greater and at least one CVD risk factor. One example of an “event” would be a heart attack. Some doctors also prescribe a statin if the event risk is 7.5% or greater. This is regardless of cholesterol number. This has resulted in patients with normal cholesterol to be placed on statins. In fact, the majority of patients with diabetes are placed on statins. In addition, a few patients with elevated cholesterol and no risk factors were taken off statins due to lack of risk factors.

@@veena-usa Allow me to be somewhat candid here, but there is something fishy about this whole statin subject. I was put on statins 11 years ago after valve repair surgery. I'm not a cardiologist but valve repair is a structural issue that, if fixed properly, like mine appears to have been, potentially needs nothing more than checkups. Yet, I was put on statins because my cholesterol numbers were "high" - and we all know the 200 number is calculated, not observed, and much of the data was captured by industry sponsored studies. All these years later, my numbers look good, but my body is wracked with muscle pain, my blood sugar is higher than it's been (which potentially puts paid to the prevarication that statins lower blood sugar) and my quality of life has been affected enough that I feel I'd rather have a cardiac event and get to the Pearly Gates than live like this, with one practically useless arm, and the other following suit as a result of having compensated for so long. And just a few days back we read that Pfizer (amazing how that name crops up again and again) pulled a sickle cell drug from the market - after passing FDA approval tests with flying colors, and more importantly, after Pfizer recorded upwards of $200 million in profit from that drug alone in 2023 - because a significant number of people who took that drug died! Speaking of the scare tactics about not stopping statins for fear of strokes and heart attacks, where are the numbers? How many people who stopped taking statins got strokes as a result? It sure would be nice to know, wouldn't it? I apologize for the frustrated tone, but one thing I do NOT want now is for my cardiologist to prescribe another medicine to address the muscle pain - which could have a million other side effects. Please forgive my rock bottom confidence in the medical industrial complex at the moment.

@@veena-usa TH-cam seems to have deleted my previous response, but allow me to summarize. I'm not buying any of this.

First, I assure you that this comment is published and TH-cam did not censor it. Sometimes comments don’t publish instantly - I’m not sure the reason. You made good points and I appreciate your comment. It sounds like you are having muscle pain and high blood sugar from your statin - which unfortunately are very real side effects. You should not have to live like that. We have other medications that came after statins and they don’t carry the same side effect profile. There is by the way, one statin (pravastatin) that is less likely than others to cause muscle pain. It sounds like you may be sick of doctors and medications and the medical industry. That makes sense with what you have been through. I have received so many comments from people that have been on statins for years and have been enduring muscle pain, brain fog and other side effects. It’s amazing! I’m not sure why their doctor is not listening and working with them to try other options. I want to encourage you to talk to your doctor. If they won’t listen to you and work with you -please find a new doctor. There really are doctors out there that will listen. I wish you the best!💕

@@veena-usa Thank you very much for your kind response. I'm going to have a heart-to-heart (sic) with my cardiologist next month. I honestly hope he gets me off of this poison.

There is a study that shows people with Type 2 Diabetes lost a bit less weight than non-diabetics while using Mounjaro. The difference was 14% of body weight vs 19%. But both groups actually did very well. Since you have pre-diabetes, I am not sure how this applies to your situation, but we know from the “slow responder” study that you have a great chance of losing a clinically significant amount of weight if you can hang in there for the long term. Yes, Mounjaro is very expensive in the US. However, the manufacturer has a "coupon" that brings the price down. It's a very complicated medical / pharmacy situation here. I have heard that we pay the highest prices for pharmaceuticals. Best of luck to you!

Thank you!

I’m so go glad for you that niacin has been successful and you are tolerating it! Thank you for sharing. I do remember the day when the everyone stopped taking niacin and our prescription version “Niaspan” was removed from our pharmacy Fast Rack. After reading your comment, I’m realizing that I didn’t go to the source and look at the study design. You have peeked my interest and I’ll check that out when I get a chance.

Well said! It’s best to check with your doctor before making any changes to your medications. I’m hoping for larger studies that are looking at this as a primary outcome.

Great question! According to the study, you do not fall into the category of being at increased risk for dementia or mild cognitive impairment (MCI)due to atorvastatin. This is because your baseline total cholesterol was 228 prior to starting atorvastatin. Statistically, you are not more likely to have dementia than someone that is not taking a statin. There is a separate uncommon side effect of statins that is referred to as “brain fog.” It’s not dementia and it reverses after stopping the statin. There is an unlikely chance that is happening. The more likely possibility is that this is caused by the stroke. I want to encourage you to talk to your doctor about your memory concerns. If you want to switch to another kind of medication and see if there is improvement, your doctor can trial you on another medication. If the memory problems lift in a few weeks, then it was the statin. But I want you to know it’s not likely the statin. In your case, because you had a stroke, the benefits for taking the statin are compelling. Good health to you; I hope you can have a great conversation with your doctor.

Wow!! Yes, you are definitely an early responder. Congratulations!🎉

Excellent! Congratulations!🎉

I hear you. I can picture it going either way. First, I want to make sure you should even have the conversation. Prior to starting your statin, was your baseline total cholesterol elevated? In the study with people of normal cognition, this association occurred if their baseline total cholesterol was below 176 mg/dl. Baseline cholesterol would be prior to starting cholesterol medication. If yours was above that number before starting, then there’s no reason to change. If you are someone in that category of low baseline cholesterol, then perhaps you can click on the links I give to the study information and print the summaries. If you bring those in and show them, then it’s published data from a study vs something you heard. Best of luck to you!

@@veena-usa My Cholesterol has always been in the Normal range, with slightly low, Good Cholesterol levels. My cholesterol was never high, ever. They have my lab results.

Okay then you are exactly who I wanted to reach. Maybe the doctor or NP will be receptive to a switch if you show the study. They may say it’s not proof - and they are right. However, it’s not harmful to simply switch. Pravastatin is the milder one and rosuvastatin is the most potent so your equivalent dose would be much lower on rosuvastatin. Even if your health care provider doesn’t want to look at it, you must be comfortable with your medication. I believe they will switch you even if it’s just to make you feel comfortable taking it.

@@veena-usa I simply stopped on my own. Voila' Problem solved. But now the Pharmacy calls and asks why I'm not asking for a refill. I'm sure they are getting kickbacks -- on anti-depressants, too. PA's should spend their time helping people navigate the OTC market -- now there's a mountain of BS.

Since I do not know your medical picture and risk factors, I cannot comment about your need for a statin or any type of cholesterol medication. I do want you to know that if you have substantial risk factors, there are alternatives to statins that are not associated with cognitive impairment. Since I am a pharmacist, I can shoot straight with you about the calls from the pharmacy. It’s true, you may receive calls from the pharmacy when you don’t refill your medication. It’s also true that a pharmacy typically benefits from folks filling prescriptions. Sometimes it is financial benefit; let’s face it, it’s a business and there must be a profit or they will not exist. However, sometimes that phone call has nothing to do with financial incentive. The pharmacist herself will not usually have anything to gain. We often reach out to patients because we have committed our professional life to keeping our patients and our community healthy and we are trusting that the doctor prescribed it in the patient’s best interest. After reading your comment, I am looking at it in a new light and I see how patients may feel that we are being disingenuous and / or annoying. Thank you for your candidness!

If it was “brain fog” (not dementia) caused by the statin then it usually reverses several weeks after stopping the statin. If not, then I hope you can see a neurologist. I’m very sorry to hear about this and I wish you the best!

That is true about Niacin. However, there was a study in 2011 that was stopped early because it was showing that the risks of Niacin were not outweighing the benefits. Since that study, I have hardly filled any prescriptions for it.

You have valid points. Thank you for bringing up the doctor that discovered that H. pylori. He literally infected himself with H. pylori to validate his hypothesis. Yes, established guidelines are a moving target -well said. Doctors will not typically go outside the guidelines (at least not in the US) because if something goes wrong, they will be sued. If someone fits the guidelines to be on a statin, the doctor must offer it. I do believe there is a place for statins, though and for secondary prevention I believe the benefit is most clear. I realize that I did not discuss muscle pain or brain fog. I wanted to get the information out to as many people as possible. I originally made a video that went into details of the study and explained almost everything and I included “brain fog” among the side effects of statins and differentiated it from dementia. That video was long (and apparently boring as heck) and it got 36 views in 5 months. I realized that by giving all the information, I was helping no one. That’s why I re-made the video short and basic. I want to reach people that could benefit from the information. Thank you for your comment. You are definitely giving people something to think about.

Very well said! Thank you for this comment.

Great comment! Normal cholesterol vs elevated (above 200 mg/dl) is simply a number that is used as a guideline in the US. It could be up to debate if the 200mg/dl cut off is too high or low. I don’t know for sure what total cholesterol number is optimal. There are conflicting studies and opinions about this topic. Additionally, total cholesterol is not seen as important as LDL or HDL ratio. In terms of the study, for people with normal cognition, the risk for converting to mild cognitive impairment (MCI) occurred if total baseline cholesterol was below 175 mg/dl. For people with MCI, the risk for conversion to dementia was in people with total baseline cholesterol below 206 mg/dl. This last number is slightly elevated, but near “normal.”

@@veena-usa Thank you. However, I think that we should entertain the possibility of reverse causation here. After all, we know that high cholesterol in midlife is a risk factor for dementia. We also have known since at least the time of the Honolulu heart study that declining cholesterol can be an early symptom of dementia eg RESULTS: Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period. The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents.

It is definitely interesting and you did a good job summarizing it. It does appear from multiple studies that both high and low cholesterol appear to correlate with dementia risk. However, if the association with converting to mild cognitive impairment and dementia has nothing to do with which statin one is taking, then why would only lipophilic statins be associated with double the risk and hydrophilic statins have the same outcome as non-statin users? Of course, we need a larger study with higher power and primary outcome to know with confidence. I admit that we don’t actually know what’s going on and we are just speculating. Since it sounds like you are interested in the emerging research, here are connections that have been/ are being studied: • Desmosterol, a precursor in cholesterol biosynthesis, has been studied for its potential link to dementia. Research indicates that lower levels of desmosterol in the brain may be associated with cognitive impairment and Alzheimer’s disease. Like low cholesterol, it’s unclear if low desmosterol could be a cause or consequence of dementia. • Lower levels of bile acids are linked to a higher risk of dementia in men. Bile acids are made from the breakdown of cholesterol. Thank you for your great comments!

@@veena-usa Thank you very much. I wasn't previously aware of the desmosterol issue To be honest, I had believed that both classes of statin significantly reduced dementia risk eg Hydrophilic statin decreased the dementia risk by 28% (RR 0.72, 95% CI 0.63-0.82, p < 0.0001), and lipophilic statin decreased the dementia risk by 16% (RR 0.84, 95% CI 0.75-0.94, p = 0.002). From: Association between Use of Statin and Risk of Dementia: A Meta-Analysis of Observational Studies by Poly et Al. Things are certainly complex but, all other things being equal, hydrophilic statins seem the better option.

@tomgoff7887 Thank you for citing studies! I’m familiar with a couple of meta-analysis studying this topic of statins and dementia. Clearly they decrease risk in the overall population. They don’t take into account baseline cholesterol so they don’t answer the question for our normal or low cholesterol folks. It’s a small population, but it does exist. By the way, the desmosterol phenomenon is currently being studied and it is still considered an association and not proven cause / effect. I appreciate your discussion points. Thank you for well thought comments!

Welcome, doctor! Thank you for commenting!

The dosing you are mentioning is extremely tiny. I’m wondering if you meant to say that you are using 0.25mg and trying to go down to 0.1mg? Or are you under the care of a doctor that is using micro-dosing? Please make sure that your doctor knows that you are titrating off Ozempic. If you are taking it for diabetes, it will be important to replace it with something else. If you had intended to say that you are on 0.25mg and are supposed to titrate down to 0.1mg, then it would be 4 clicks on a 2mg max dose pen (gold and white box) to get approximately 0.1mg. Remember to discard the pen 8 weeks after first use. If you really did mean that you are on 0.025mg and need to titrate down to 0.01mg, then it’s not possible. It would be less than 1 click. That dose would be considered very tiny - even smaller than a typical micro-dose. Make sure you and your doctor are on the same page. The dose sounds so small that I’m concerned you may have misunderstood your doctor. Best of luck titrating off!