From the Guidelines
The patient should be treated with comprehensive lifestyle intervention, including a reduced-calorie diet, exercise or increased physical activity, and behavioral guidance, to manage his obstructive sleep apnea (OSA) and reduce the risk of cardiovascular comorbidities, as recommended by the American Thoracic Society clinical practice guideline 1. The patient is a 70-year-old male with OSA who is currently taking amlodipine 5 mg daily for hypertension, rosuvastatin 10 mg daily for cholesterol management, and Xarelto (rivaroxaban) 20 mg daily, likely for anticoagulation. Key considerations for his treatment include:
- Continuing his current medications as prescribed, with amlodipine and Xarelto taken daily and rosuvastatin for the prescribed 90-day period
- Monitoring for potential drug interactions, particularly between rivaroxaban and amlodipine, which may slightly increase bleeding risk 1
- Regular follow-up appointments to assess OSA control, medication effectiveness, and any side effects
- Weight management, avoiding alcohol before bedtime, and sleeping in a lateral position can also help manage OSA symptoms alongside CPAP therapy and medications It is essential to note that the patient's medication profile suggests existing cardiovascular issues, and untreated OSA can increase cardiovascular risks. Therefore, proper CPAP compliance and comprehensive lifestyle intervention are crucial to reduce the risk of cardiovascular comorbidities and improve the patient's quality of life, as supported by the American Thoracic Society clinical practice guideline 1.
From the FDA Drug Label
Of the 10,275 patients in clinical studies with rosuvastatin, 3,159 (31%) were 65 years and older, and 698 (6. 8%) were 75 years and older. No overall differences in safety or effectiveness were observed between these subjects and younger subjects. Advanced age (≥65 years) is a risk factor for rosuvastatin-associated myopathy and rhabdomyolysis Dose selection for an elderly patient should be cautious, recognizing the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy and the higher risk of myopathy. Monitor geriatric patients receiving rosuvastatin for the increased risk of myopathy [see Warnings and Precautions (5.1)] .
The patient, a 70-year-old male, is taking rosuvastatin 10 mg tablet once daily.
- The dosage of 10 mg daily is within the recommended range for elderly patients.
- However, due to the patient's advanced age, there is an increased risk of myopathy and rhabdomyolysis.
- It is essential to monitor the patient for the development of myopathy.
- Dose selection should be cautious, considering the patient's overall health and potential concomitant diseases or drug interactions 2.
From the Research
Medications and Their Effects
- The patient is taking amlodipine 5 mg tablet, which is a calcium channel blocker, once daily by mouth 3.
- The patient is also taking rosuvastatin 10 mg tablet, which is a statin, once daily by mouth for 90 days 4.
- Additionally, the patient is taking Xarelto 20 mg tablet, which is an anticoagulant, once daily by mouth.
Obstructive Sleep Apnea (OSA) and Its Treatment
- OSA is a common disorder that affects quality of life and is associated with comorbidities such as hypertension, atrial fibrillation, heart failure, coronary heart disease, type 2 diabetes mellitus, and stroke 5.
- The treatment of OSA includes weight loss, exercise, positive airway pressure, oral appliances, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway 6.
- Positive airway pressure is the first-line treatment for adults with OSA, and weight loss is a beneficial adjunct to treatment 5.
Effect of Treatments on Blood Pressure
- Continuous positive-airway pressure (CPAP) has been shown to lower blood pressure in patients with OSA 3.
- Statins, such as rosuvastatin, have been shown to improve lipid profile and lower blood pressure in patients with OSA 4.
- Calcium channel blockers, such as amlodipine, have been shown to reduce blood pressure in patients with hypertension 3.