Pitavastatin

I’ve responded to other Pita threads and have one of my own but will just share my experience.

Switched from rosuva 5 to pita 2 while at the same time increasing my androgen load by more than 50% and my ApoB / LDL stayed the same, with Lp(a) dropping by 65% (was already low). I’ve since increased to 4 mg and increased androgen load another 30%. LDL is 68 and the goal is around 30 (based upon research showing that for every drop in LDL of 37 points you reduce risk by 20%). Will be adding Zetia 10 mg depending on next round of bloods. Will add bemp acid if needed.

I’ve had no side effects whatsoever (though I know a good bro on here who has had joint issues from pita).

I pay $50/mo with a good Rx coupon. Will be switching to costplus
 
You made it sound so simple, made me feel dumb.
Can I ask for metformin as well or other meds?

Yes, but maybe not on the same appointment (well, you can try AFTER they agree to prescribe the first two, it has worked for me in the past. Some of the doctors/nurses are happy to prescribe 3 meds).

If not; just make another appointment under "General health care" for another $19. Although you could try to get a new prescription, it's easiest if you just say "I was on 500mg metformin 3x a day for weight control a few years ago and it worked very well for me. I've put quite a bit of weight back on and would like to get back on it again". This removes a lot of complexity by reassuring them you've successfully used it in the past.

Even if your insurance doesn't pay for it, in the example above, the cash price using GoodRx coupon is less than $20 for 270 500mg tablets.
 
Yes, but maybe not on the same appointment (well, you can try AFTER they agree to prescribe the first two, it has worked for me in the past. Some of the doctors/nurses are happy to prescribe 3 meds).

If not; just make another appointment under "General health care" for another $19. Although you could try to get a new prescription, it's easiest if you just say "I was on 500mg metformin 3x a day for weight control a few years ago and it worked very well for me. I've put quite a bit of weight back on and would like to get back on it again". This removes a lot of complexity by reassuring them you've successfully used it in the past.

Even if your insurance doesn't pay for it, in the example above, the cash price using GoodRx coupon is less than $20 for 270 500mg tablets.


I actually tried this before with another teleprovider and they asked me for proof lol
 
If anyone needs inspiration, my lipids from September 2024:

IMG_2872.webp

To September 2025:

IMG_2840.webp

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).

IMG_2880.webp

Other meds are: 15mg Tirz, 40mg Telmisartan , 20mg Cilnidipine, 10mg Cialis, 100mcg T4, 5mg Selegiline. Supplements are multivitamin, K2+D3, Magnesium Threonate, Taurine, Creatine.
 
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@Ghoul
You’re the man Ghoul, I got it prescribed.
How are they told me they don’t refill the prescription but that’s an issue for another time

When I go back home on December, I’m probably gonna stack up on them, more expensive cuz it’s branded tho. It’s OTC in the middle east/Europe
 

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@Ghoul
You’re the man Ghoul, I got it prescribed.
How are they told me they don’t refill the prescription but that’s an issue for another time

When I go back home on December, I’m probably gonna stack up on them, more expensive cuz it’s branded tho. It’s OTC in the middle east/Europe

Yes, the only downside is no refills, another $19 appt each 3 months.

But with a prescription bottle in hand, in my experience any doctor will be willing to refill it in the future.
 
@Ghoul
You’re the man Ghoul, I got it prescribed.
How are they told me they don’t refill the prescription but that’s an issue for another time

When I go back home on December, I’m probably gonna stack up on them, more expensive cuz it’s branded tho. It’s OTC in the middle east/Europe

Dam u faked the rx?
 
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.

The amazing part is not the LDL, it's the HDL.
 
The amazing part is not the LDL, it's the HDL.

Pitavastatin has the best effect on HDL of all statins. Not just amount, but HDL efflux function (the ability to remove cholesterol) is significantly improved. This may be more important than the quantity of HDL.


I'm going to drop Test to 150mg/wk to hopefully get another 10 points HDL. It seems the most regression is achieved with HDL >50, and I don't want to fall below that.

"LDL should be reduced to <80 mg/dL, and HDL increased to >45 mg/dL to regress coronary plaques."


In Glacov (the big repatha trial) LDL in 20's and 30's, with HDL ~50 saw a 1% reduction in PAV (Percent Atheroma Volume, aka plaque) after 78 weeks.

“A 1% reduction of PAV… was associated with a 25% reduction in MACE (Major Adverse Cardiac Events).”

 
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Pitavastatin has the best effect on HDL of all statins.

I'm going to drop Test to 150mg/wk to hopefully get another 10 points HDL. It seems the most regression is achieved with HDL >50, and I don't want to fall below that.

"LDL should be reduced to <80 mg/dL, and HDL increased to >45 mg/dL to regress coronary plaques."


In Glacov (the big repatha trial) LDL in 20's and 30's, with HDL ~50 saw a 1% reduction in PAV (Percent Atheroma Volume, aka plaque) after 78 weeks.

“A 1% reduction of PAV… was associated with a 25% reduction in MACE (Major Adverse Cardiac Events).”


I know, i'm on it.
But my HDL is as good as my LDL, single digits.
It's probably due to AAS use.

I'm honestly surprised you're on so little medications.
 
I'm hearing from many people it's an uphill climb to get PCPs to prescribe it. Many are unfamiliar with it.

Why are doctors reluctant to prescribe pitavastatin? It seems to me that it's a no brainer: It's the third most effective statin in terms of cholesterol reduction. It has minimal effects on the liver. It's less likely than the others to cause muscle pain. It's less likely to interact with other drugs than the other statins.
 
Why are doctors reluctant to prescribe pitavastatin? It seems to me that it's a no brainer: It's the third most effective statin in terms of cholesterol reduction. It has minimal effects on the liver. It's less likely than the others to cause muscle pain. It's less likely to interact with other drugs than the other statins.

Clinical inertia. Unfamiliarity.

Only became available as a generic in 2024, and until then insurance companies would only cover it as a last resort when no other statin could be tolerated, and ezetimebe + bempodoic acid wasn't enough.

Most statins are under $10 for a 90 day supply. Pitavastatin was until recently:

IMG_2883.webp

I think it'll become the #1 statin in a few years as it continues its to get cheaper.
 
Clinical inertia. Unfamiliarity.

Only became available as a generic in 2024, and until then insurance companies would only cover it as a last resort when no other statin could be tolerated, and ezetimebe + bempodoic acid wasn't enough.

Most statins are under $10 for a 90 day supply. Pitavastatin was until recently:

View attachment 352397

I think it'll become the #1 statin in a few years as it continues its to get cheaper.
What you wrote makes sense.
 
What you wrote makes sense.
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.
 
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