Patient Suffers Kidney Complications After Being Overprescribed Cholesterol Medication

ByWendy Ketner, M.D.

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Updated onApril 11, 2019

This case involves an 83-year-old woman who was dispensed 80 mg of Lipitor per day in spite of the fact that her cholesterol and triglycerides were normal. After a visit to her family medicine doctor, the patient was prescribed an additional 20 mg on top of her 80 mg prescription. Several weeks after she began taking the full 100mg dosage, she experienced severe muscle aches and red-colored urine. She went to the emergency room and was diagnosed with rhabdomyolysis. The patient later suffered kidney complications secondary to the quantity of myoglobin in her blood. It was alleged that that the patient’s rhabdomyolysis was directly caused by the over-prescription of Lipitor. An expert pharmacologist was sought to review the records and testify on liability and causation of the patient’s rhabdomyolysis.

Question(s) For Expert Witness

1) Please describe your experience dispensing Lipitor?

2) Have you ever lectured or published on statins? Please explain.

Expert Witness Response E-083201

inline imageI am a certified lipid specialist, a board certified pharmacotherapy specialist, a board certified ambulatory care pharmacist, and a recognized as a national expert in the area of statin medications. I have an extensive history of teaching, conducting research, and providing patient care in the area of hypercholesterolemia. I am also on the National Lipid Associations Board of Directors and recently served as the co-chair of an association for the safe use of statin medication. In my practice, I am involved with starting, stopping, titrating and monitoring patients on Lipitor and other statins. I also train pharmacy students on how to dispense, counsel patient and assure appropriate use of this medication in practice.

inline imageThe amount of Lipitor taken by the patient was excessive. The maximum dose is 80 mg, and consuming Lipitor in excess of this dose is unreasonable and unsafe. Moreover, use of 80 mg of this medication is considered high-intensity, which is only recommended for the management of patients with clinical atherosclerotic vascular disease [ASCVD] (e.g., history of myocardial infarction, ischemic stroke), patients with familial hypercholesterolemia (as evidenced by a pre-treatment LDL-C of >/= 190 mg/dL), or possibly a patient with a very high predicted 10-year risk score of ASCVD that is at least 7.5%. It sounds unlikely that this patient met these criteria. Moreover, using high-intensity statin therapy is potentially problematic in patients who are elderly.

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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