96
Complications of Management
Table 25. Safety Considerations for LDL-C–Lowering
Medications
Medication Class Common Side Effects Contraindications*
HMG-CoA
reductase inhibitors
(statins)
Myalgia (normal CK level)
is common and dose-related
Acute liver failure;
decompensated cirrhosis;
lactation; severe underlying
neuromuscular diseases
(eg, dermatomyositis, muscular
dystrophy)
Cholesterol
absorption inhibitor
(ezetimibe)
Typically well tolerated Prior hypersensitivity to
ezetimibe
PCSK9 inhibitor:
monoclonal
antibodies
(alirocumab,
evolocumab)
Injection site reactions Prior hypersensitivity to the
PCSK9 monoclonal antibody
ATP citrate
lyase inhibitor
(bempedoic acid)
Typically well tolerated Prior serious hypersensitivity
reaction to bempedoic acid or any
of the excipients
PCSK9 inhibitor:
small-interfering
RNA (inclisiran)
Injection site reactions Prior serious hypersensitivity to
inclisiran or any of the excipients
Bile acid sequestrants Abdominal pain, bloating,
dyspepsia, nausea, and
constipation are common
TG >500 mg/dL (colesevelam);
history of hypertriglyceridemia-
induced pancreatitis; bowel
obstruction
