Pitavastatin

[Ghoul]

Another reason, it is often non-formulary for alot of insurances, they prefer rosuvastatin/atorvastatin/pravastatin. How do I know this? Just was placed on pita and insurance immediately balked for prior auth, would have been non preferred pricing, went with costplusdrugs for 25 bucks no insurance.

That's rapidly changing since the generic became available. Caremark is the largest pharmacy benefit manager for insurers for instance, and the generic became a preferred Tier 1 drug in the 2025 formulary, putting it the lowest drug copay category (or free for 40+).

So even if you're not covered now, be sure to check the 2026 formularies coming out shortly.

 

[Wizbang]

That's rapidly changing since the generic became available. Caremark is the largest pharmacy benefit manager for insurers for instance, and the generic became a preferred Tier 1 drug in the 2025 formulary, putting it the lowest drug copay category (or free for 40+).

So even if you're not covered now, be sure to check the 2026 formularies coming out shortly.

Good to know, the bureaucracy of health insurance is a bit ridiculous, glad they're coming to their senses. When I asked my local pharm how much the pita was generic I was quoted 271.00 for 30 pills, to me that is an absolute disgrace when I ended up paying less than $1/pill cash elsewhere.

 

[Ghoul]

Good to know, the bureaucracy of health insurance is a bit ridiculous, glad they're coming to their senses. When I asked my local pharm how much the pita was generic I was quoted 271.00 for 30 pills, to me that is an absolute disgrace when I ended up paying less than $1/pill cash elsewhere.

And for however long India PCT remains available, Pivasta 4mg is only ~$45 / 100 for from there, without the hassle of a prescription. For some odd reason there are combo pills with ezetimibe for even less. I think it's because Pivasta is from a premium international brand and the combos from lesser known manufacturers.

 

[Wizbang]

And for however long India PCT remains available, Pivasta 4mg is only ~$45 / 100 for from there, without the hassle of a prescription. For some odd reason there are combo pills with ezetimibe for even less. I think it's because Pivasta is from a premium international brand and the combos from lesser known manufacturers.

I am very worried about exactly "how long".

 

[Ghoul]

I am very worried about exactly "how long".

Those awesome all aluminum strips the Indian pharma companies use to protect meds from the tropical climate really couldn't create a more ideal packaging environment for long term storage. Protected against, light, oxygen, moisture.

98% of tabs, kept in the fridge especially, but any cool area will suffice, will very likely remain potent for a decade or beyond, as numerous studies by DOD, NASA, etc, have established.

 

[Photon]

Other meds are: 15mg Tirz, 40mg Telmisartan , 20mg Cilnidipine, 10mg Cialis, 100mcg T4, 5mg Selegiline. Supplements are multivitamin, K2+D3, Magnesium Threonate, Taurine, Creatine.

Did you stop taking Modafinil?

 

[Ghoul]

Did you stop taking Modafinil?

No, though I've had to lower the dose significantly because after starting selegeline it's potency seemingly doubled or tripled, same for caffeine. Low dose Seleg doesn't have much of an impact you can clearly "feel", it's subtle, but anything that increases dopamine levels or sensitivity seems to be greatly amplified. Coffee consumption is 1/3 of what it had been previously, otherwise I'm trembling like a crack addict.

 

[Photon]

No, though I've had to lower the dose significantly because after starting selegeline it's potency seemingly doubled or tripled, same for caffeine. Low dose Seleg doesn't have much of an impact you can clearly "feel", it's subtle, but anything the increases dopamine levels or sensitivity seems to be greatly amplified. Coffee consumption is 1/3 of what it had been previously, otherwise I'm trembling like a crack addict.

I did 1/2 of a 5mg pill of selegeline daily, like 10+ years ago for RLS.
It made me more impatient and irritable over time (effects build up, irreversible inhibitor) and seemed to make my ocd worse so i dropped it.

Things might be different now due to age, idk.

 

[Ghoul]

I did 1/2 of a 5mg pill of selegeline daily, like 10+ years ago for RLS.
It made me more impatient and irritable over time (effects build up, irreversible inhibitor) and seemed to make my ocd worse so i dropped it.

Things might be different now due to age, idk.

I like it. Everything feels "smoother", physically and mentally, Which makes sense I suppose. Parkinson's induces that "stuttering" state of existence, which this treats, so my perception of movement and sensory input feeling more "fine grained" and precise has some rationale supporting it.

Mostly though, I'm in it for the preservation of dopamine levels without burning out the emitters so the capacity to produce it isn't diminished over the long term as aging tends to cause. Preventing the "Dopamine diabetes" that develops over time, basically.

 

[bubba618]

Is there a way to get prescribed Pita to purchase it, TelyRx is like $150+ for the same supply? Would like to be able to source it domestically. Ik Indian pharma is solid but I am always skeptical and domestic is always better if price's match.

I quite literally told my doctor that she didn't need to be concerned what insurance would approve or not as I could cover the cost out of pocket using CostPlus for less than insurance copays would be. I had printed out the list of meds I wanted her to prescribe, the reasoning behind each, and a comparative list of prices from CostPlus and my pharmacy plan.

 

[Laxman3221]

Sorry if that's not clear. The liver LDL receptors "capture" LDL floating by. The outer"shell" of LDL particles is APO-b. Inside these containers is a "cargo" of LDL and triglycerides.

The liver breaks all this down as I described.

PCSK9, naturally produced by the body, blocks this from happening, which is not good for cholesterol levels. People produce more or less PCSK9 based on genetics. The more you produce the worse your LDL levels will be.

PCSK9 *inhibitor* drugs reduce the amount of PCSK9, leaving LDL receptors on the liver free to remove LDL from your blood and break it down, lowering LDL levels.

This is what you want. All of it being broken down, including the APO-b, instead of circulating freely until it builds up as plaque in your arteries.

So, if you have high LDL, like 250+ but low APO-B and LPa do you need to reduce your LDL number with a drug?

 

[Ghoul]

So, if you have high LDL, like 250+ but low APO-B and LPa do you need to reduce your LDL number with a drug?

No, at that level you wouldn't need to reduce it with a drug, you'll need multiple drugs. If don't want to make it highly likely you'll die from the #1 cause of death or paralyzed from a stroke. At an LDL of 250 or higher, you’re sitting on a cardiovascular time bomb, no matter how pretty your ApoB or Lp(a) look. That level means your blood is overflowing with cholesterol, and physics guarantees it’s slamming into your artery walls every second. Low ApoB doesn’t save you, it just means fewer bullets, each carrying a bigger payload. Every genetic, clinical, and imaging study agrees that high LDL drives plaque, heart attacks, and strokes. There are no exceptions for "big, fluffy LDL".

The only good news is that at that level it's familial hypocholestorimia, so you could get Repatha prescribed pretty easily.

 

[Lifting88]

If anyone needs inspiration, my lipids from September 2024:

View attachment 352358

To September 2025:

View attachment 352359

This is with Pitavastatin 4, Ezetimebe, and Repatha. The Repatha is only adding 10-12% more improvement to the other two though.

After these, and stress echo + CPET results were sent, my preventative cardiologist added a note:

"You have undergone a complete cardiometabolic risk inversion. From a 10-year ASCVD risk near 18%, you now present with optimal blood pressure, an LDL profile in the lowest 0.1% of the population, and endurance-level aerobic fitness. Your current risk is ~2%, likely closer to 1% or less in reality. It's one of the most dramatic reversals of cardiovascular risk I've ever seen."

Not noted here is my A1C 4.8%, and my HS-CRP (systemic / arterial) inflammation dropping from 3.0 (normal for a 65+ year old, not 50) down to 0.4, expected in an early 20's athlete.

I'm well into maximum plaque regression and stabilization territory, as lipids move out of my arteries, and the remaining material turns into a tough fibrous cap not susceptible to rupturing and causing a blockage.

For context, this is on 200mg / wk Test-C, 4iu rHGH, and a diet high in saturated fat (mostly from meat, whole eggs, but also full fat dairy, coconut milk, etc).

View attachment 352370

Other meds are: 15mg Tirz, 40mg Telmisartan , 20mg Cilnidipine, 10mg Cialis, 100mcg T4, 5mg Selegiline. Supplements are multivitamin, K2+D3, Magnesium Threonate, Taurine, Creatine.

How you get a good shbg on trt

Im always singdl digit like 7 or 8 mnol

 

[Ghoul]

How you get a good shbg on trt

Im always singdl digit like 7 or 8 mnol

I optimize thyroid hormones, keeping T3 at the higher end of normal, which stimulates high SHBG synthesis in the liver.

Also my high e2 (83) increases SHBG.

and

Insulin suppresses SHBG. Tirz keeps my
sensitivity high so insulin levels are low, even on rHGH.

 

[Ghoul]

How you get a good shbg on trt

Im always singdl digit like 7 or 8 mnol

I forgot about thyroid function, probably the most important part, and updated my comment with the info.

 

[Superchicken]

So, if you have high LDL, like 250+ but low APO-B and LPa do you need to reduce your LDL number with a drug?

Have you checked your LDL-P to see where it’s at? The discordance between LDL and ApoB often points to insulin resistance. I ask because mine were discordant and my insulin was 9.4. That’s well within range, but I follow Peter Attia’s advice that optimal is no higher than 5. I had to dig to figure it out, because drs said it’s just fine.

Also this may be of use, it says LDL to ApoB ratio is a better indicator than ApoB alone. Low-density lipoprotein cholesterol/apolipoprotein B ratio... : Coronary Artery Disease

I assume if you’ve been aware of those numbers and left it untreated that you’re wary of statins because of how they’ve been demonized. I found this podcast episode to be insightful and it discussed common misconceptions. My husband was in the ‘never statin camp’ until he listened to it.


View: https://podcasts.apple.com/us/podcast/the-peter-attia-drive/id1400828889?i=1000688421241

 

[newguy2]

This thread is incredibly helpful. @Ghoul thanks for all you knowledge man. I have pita showing up in a few days. Excited to see what it can do.

I recently did a calcium test with my new PCP. Everything came back to I'm just finishing up a blast and have a lab order with my PCP to check lipids.

Do you think I should do the lab while my lipids are the worst from this blast to try and get a script for pita. Or recover them a bit?

I'm reluctant to start the pita on the side and then him say everything looks good no need for a statin.

But also always a bit nervous if having trashed blood work could negatively impact insurance somehow.

 

[Ghoul]

This thread is incredibly helpful. @Ghoul thanks for all you knowledge man. I have pita showing up in a few days. Excited to see what it can do.

I recently did a calcium test with my new PCP. Everything came back to I'm just finishing up a blast and have a lab order with my PCP to check lipids.

Do you think I should do the lab while my lipids are the worst from this blast to try and get a script for pita. Or recover them a bit?

I'm reluctant to start the pita on the side and then him say everything looks good no need for a statin.

But also always a bit nervous if having trashed blood work could negatively impact insurance somehow.

Have you ever had lipids checked? On or off cycle, any idea what LDL was?

 

[deadbeef]

I actually tried this before with another teleprovider and they asked me for proof lol

Get 1 month on telyrx. Now you have a valid prescription to show when they ask for proof. I was able to get refill prescriptions of a few meds from goodrx using this strategy.

 

[newguy2]

Have you ever had lipids checked? On or off cycle, any idea what LDL was?

Yes. LDL was 100 last time on TRT. A could months ago. HDL 29.