From the Guidelines
The patient should continue taking both atorvastatin and metformin as prescribed, as the cold-like symptoms are likely unrelated to these medications and stopping them could negatively impact diabetes and cholesterol management. The cold-like symptoms experienced by this patient are typically caused by viral infections and not by these particular drugs [ 1 ]. The patient should treat the cold symptoms with standard supportive care including rest, adequate hydration, and over-the-counter cold remedies if needed.
Key Considerations
- Cold symptoms are usually self-limiting and resolve on their own within 7-10 days.
- If cold symptoms persist beyond 7-10 days, worsen significantly, or if the patient develops fever above 101°F, shortness of breath, or severe fatigue, they should contact their healthcare provider.
- While statins like atorvastatin can occasionally cause muscle aches and metformin can cause gastrointestinal side effects, neither typically causes cold-like symptoms such as runny nose, cough, or sore throat [ 1 ].
- Maintaining glycemic control and managing cholesterol levels are essential for reducing long-term cardiovascular complications in type 2 diabetes.
Management of Statin Therapy
- According to the 2013 ACC/AHA guideline, if unexplained severe muscle symptoms or fatigue develop during statin therapy, the statin should be promptly discontinued and the possibility of rhabdomyolysis should be addressed [ 1 ].
- However, in this case, the patient's symptoms are cold-like and not indicative of severe muscle symptoms or fatigue, so discontinuation of atorvastatin is not necessary at this time.
Ongoing Care
- The patient should be monitored for any changes in their condition or the development of new symptoms.
- Regular follow-up appointments with their healthcare provider are crucial to adjust the treatment plan as needed and to ensure that their diabetes and cholesterol levels are well-managed.
From the Research
Patient's Condition
The patient has been diagnosed with type 2 diabetes and high cholesterol, and has been started on atorvastatin 20 mg and metformin ER 500 mg. The patient is now experiencing cold-like symptoms.
Possible Side Effects of Medication
- The combination of atorvastatin and metformin has been shown to be well-tolerated, with mostly gastrointestinal adverse events being reported 2.
- The most common side effects of atorvastatin include headache, nausea, and muscle pain, while metformin can cause diarrhea, nausea, and abdominal pain.
- However, cold-like symptoms are not typically associated with atorvastatin or metformin.
Efficacy of Combination Therapy
- Studies have shown that the combination of atorvastatin and metformin is effective in reducing HbA1c and LDL-C levels in patients with type 2 diabetes and dyslipidemia 3, 4.
- The combination therapy has also been shown to have a preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia 3.
- The molecular mechanisms of action of statin and metformin therapy in patients with diabetes and dyslipidemia have been critically assessed, and a hypothesis for mechanisms underlying interactions between these drugs in combination therapy has been developed 5.
Effects on Inflammatory Markers
- The combination of atorvastatin and metformin has been shown to reduce inflammatory markers, such as TNF-α, in patients with diabetes mellitus type 2 6.
- The combination therapy has also been shown to partly prevent the glucose-loading induced elevation of glucose levels, suggesting a better response to glucose intake than monotherapy with metformin 6.