#909

That video scared the heck out of me!

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#910

Yes it’s approved at the EU level ( Nilemdo | European Medicines Agency (EMA) ) but big pharma often doesn’t bother to launch in smaller markets (typically Eastern EU). The new EU pharmaceutical legislation will change that. But in the meantime we need to find alternatives. In the UK pharmacies are okay to post drugs and EU prescriptions are still valid in the UK (Brexit agreement). I don’t know if they can post to outside the UK though.

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#911

This Dutch online pharmacy delivers all around the world legally and they have bempedoic acid: https://everyone.org/nexletol-bempedoic-acid

However they seem to sell the US version so of course 10x more expensive for the exact same thing…

I really want to launch an online pharmacy to solve that problem but it must be such a nightmare…

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#912

This is exactly the problem. However, I live in one of the Scandinavian countries. I don’t think that local doctors write prescriptions for medicines that are not available here. Of course I could try through EU-doctor? And then I could order from Italy, etc. Or it could be a good reason to go there on vacation.

@mccoy , what does Nilemdo cost in Italy?

#913

OMG,for that price you can already get PCSK9.

#914

EUDoctor’s chatbot claims this:
“The prescription can be used in a pharmacy within a month and can only be used once.”

Is this really the case?

#915

It’s the case theoretically. But if you print the EU Doctor prescription n times at home and go to n pharmacies you’ll get what you want n times (this is true about all non electronic prescriptions).

In general, if you write “Name of drug + date + signature” on a piece of paper, the pharmacist will give it to you (unless it’s an opioid or some weird drug).

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#916

By the way it’s legal to buy outside the EU and bring to Finland: Bringing medicines to Finland - EU-terveydenhoito.fi

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#917

The pricelist is about 120 € per 28 180 mg pills
It’s interesting to compare it to other lipids lowering drugs per 4 weeks or 1 months (Zetia) of intervention.

Crestor: 7 € each 28 -5 mg pills box
Zetia: 23 € each 30 -10 mg pills box
Nilemdo: 120€ each 28 -180 mg pills box
Repatha: 647 € per 2 140 ml injectable pen

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#918

I didn’t know that, but anyway you need a prescription to make it legal.

#919

It’s extremely easy to get a prescription (e.g. from EU Doctor). And in any case, no one will ask you for a prescription in most non EU countries (e.g. Turkey) and I don’t think anyone will check at your arrival in Finland, they have other priorities than bempedoic acid :slight_smile:

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#920

This discussion made my brain ruminate on the preventional aspect of CV health. My risk appetite is pretty low, so the ideal strategy to me (and others with similar inclinations) would be an optimization which would include the following parameters.

  • Decrease in LDL/ApoB: to be maximized - of reasonable quantities

  • Potential side effects: to be minimized - absolute priority

  • Cost: to be minimized - within reason

One possible solution would be alternating 5 mg crestor every other day and 10 mg Zetia every other day. Tom Daysprings in one of his recent podcasts hinted at the efficacy of an intermittent dosage of Zetia, concept which may perhaps be extrapolated to crestor as well.
Cost of the above would be (7+23)/2 = 15 € every 4 weeks period (presently about 16.5 US$).
Efficacy with zero or trivial risk may be increased by adding berberine, which should provide a 10 mg/dL decrease on average, but with the dosages suggested (about 1000 mg/d) it would turn out to increase costs substantially, although the main priority in this scheme would be minimization of side effects.

#921

If you experience muscle pain or weakness from any statin, you should try another statin. Initially I was taking a low dose Rosuvastatin Crestor. I had severe muscle weakness. I switched to low dose Atorvastatin Lipitor and there were no noticeable side effects. My LDL and ApoB dropped from 65 to 48. I’m extremely happy with the results.

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#922

Why would ezetimibe (Zetia) be better every other day than every day? And why not just split the pill in half and take 5 mg per day?

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#923

Yes - or even split the ezetimibe into 1/4 tablets: Pill Splitting Ezetimibe and Bempadoic Acid to Save Money, Lower Side-effect risk

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#924

An efficacious dosage of 1/4 of a pill is great news, from the standpoint of collateral effects and that of cost, which for the outlined strategy would drop at 3.5+(23/4) = about 9 € or 10 US$ every 4 weeks.
I wouldn’t be able to split the minuscule Zetia pill in 4, splitting in two would not be easy but feasible unless there are precision pill-splitting devices.

I believe Daysprings said something about an intermittent dosage but I may be wrong since English is not my mother tongue and he sometimes talks in a hurried fashion. I would have no probs in taking 5 mg per day, although 2.5 per day would be impossible unless a precision device is used for splitting.
Splitting Crestor in half would also be all right, If the dose-response is linear until 5 mg, 2.5 mg/d should yield a decrease of about 20 mg/dL LDL, summed to a conservative 10 from Zetia plus a conservative 5 from Berberine, hypothesizing simple additive effects with no synergy nor anti-synergy.

Minus 35 mg/dL from a very cautious (and inexpensive) scheme as the above would sound satisfactory, if starting from a moderate level.

#925

” the lowest dose of rosuvastatin that is marketed, 5 mg, reduces LDL-cholesterol by 45% on average, still more than initially necessary for many patients.
Not mentioned in the recent ATP3 guidelines4 is the fact that 2.5 mg and 1 mg of rosuvastatin reduce LDL-cholesterol by an average of 42% and 34%”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17304-2/fulltext

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#926

Thanks for another good news! I read the abstract of the original paper from Olsson et al., 2001, and it’s really incredible that one mere mg of rosuvastatin can decrease the LDL by 34% on average. The only issue I see here is to split a Crestor pill in 5 parts, maybe a solution could be to split the pill in 2 halves, to be taken intermittently every other day, making it an average 1.25 mg daily dose and potentially a greater than 34% reduction in LDL.

1 Like
#927

Yes rosuvastatin 2.5 mg + ezetimibe 5 mg will probably reduce by more than 40 mg.

There are pill cutters on Amazon. It might be even cheaper to buy rosuvastatin + ezetimibe as single pill and cut that (although I don’t know how the two drugs are “arranged” on the single pill).

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#928

Great idea, just ordered one, looks precise enough to get four 1.25 mg pieces from a single 5 mg pill and sure better than the crappy one I have.
image

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