Other Conditions
18
Table 5. Medications for Additional LDL-C Reduction in
Patients Taking Statins (maximal tolerated doses)
Medication Mechanism of action Dose for LDL-C reduction
Ezetimibe Binds to Nieman Pick N1L1
receptor and prevents absorption
of cholesterol from GI tract
10 mg daily
Alirocumab* Prevents degradation of LDL
receptor by inhibiting PCSK9
75 mg Q 2 wks or 300 mg Q
4 wks
Evolocumab* Prevents degradation of LDL
receptor by inhibiting PCSK9
140 mg every 2 wks SC or 420
mg SC once monthly
Cholestyramine Bile acid sequestrant 8–16 g daily in divided doses,
once or twice a day starting
with 4 g
Colesevelam Bile acid sequestrant 1250–1875 mg PO BID
Bempedoic acid ATP citrate lyase inhibitor,
inhibitor of cholesterol synthesis
180 mg PO daily
* Alirocumab and evolocumab are indicated to reduce the risk of ASCVD events in patients
with established CVD. ey are also indicated as adjunct to diet alone, or in combination with
other lipid lowering therapies to reduce LDL-C in patients with primary hyperlipidemia (e.g.,
heterozygous FH). Evolocumab is also approved alone in combination with other lipid lowering
therapies in patients with homozygous FH who require additional lowering of LDL-C. e other
medications in this table are not indicated to reduce ASCVD events.
