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Q
I currently take 40mg (in the evening) of Zocor for cholesterolemia and 40 mg of Prilosec for GERD (20 mg morning/20 mg evening) and have been taking them for about a year now. Immediately prior to taking Zocor, I was taking 20 mg of Pravachol and before that I was taking 20 mg of Mevacor. The Mevacor was effective; the Pravachol less effective; and now the 40 mg Zocor have been very effective in reducing my cholesterol levels (total less than 200) and improving my ratio of HDL to LDL (3.9 to 1).

However, certain problems have surfaced. First, for the past eight months or so, I have experienced partial impotence (can't maintain or attain full erection most of the time). I don't recall this problem during the periods I was taking Pravachol or Mevacor. Plus, I recently developed gynecomastia which required surgery to remove a mass of about 1.5"x1"x0.5". Literature I have read indicates that all three cholesterol drugs may cause impotence, loss of libido, etc., but such occurrences are infrequent. Further, all three and Prilosec may cause gynecomastia.

My questions are:
(1) can the dosage increase and/or the use of a different "statin" medicine have caused the impotence problem?

(2) can the dosage and/or the change of "statin" medicine have caused the gynecomastia, particularly with a dosage of 40 mg of Prilosec which may also be associated with gynecomastia? (3) would it be advisable to return to taking Mevacor (at the normal 20 mg dosage that I originally took cholesterol medicine) and to also see if I can tolerate a reduced dosage of Prilosec (20 mg) to see if the impotence problem improves and to avoid further gynecomastia problems?

Thanks for your thoughts.

A
The effects you mention are dose-related but there are no data to suggest a potentiating (synergistic) effect. The effects, identical for both the drugs you are currently taking are, therefore, purely additive. For this reason, it's important to look at where you are on the potential benefit/disadvantage seesaw.

It's also helpful to look at earlier therapy where you didn't experience these effects -
Pravachol (provastatin) - 20 mg./day,
Mevacor (lovastatin) - 20 mg./day.
Both are 'middle-of-the-range' dosages.

Now today -
Zocor (simvastatin) - 40 mg. single dose /day,
Prilosec (omeprazole) - 40 mg./day.
The simvastatin - you're at the maximum recommended daily dose - range is 5 -40 mg./day, the omeprazole - you're at twice the recommended dosage.

These data suggest that a reduction in dosage of both might well reduce/eliminate the unwanted effects you're experiencing while retaining much/all the benefits you might expect. It would be worth discussing the matter with your physician.

You don't mention your age, but both loss of libido and erectile dysfunction are not uncommon as one ages.