18
Treatment
Table 7. Nonstatin Safety Recommendations (continued)
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
Safety of Niacin (continued)
4. To reduce the frequency and severity of adverse cutaneous
symptoms, it is reasonable to:
• Start niacin at a low dose and titrate to a higher dose over a
period of weeks as tolerated.
• Take niacin with food or premedicating with aspirin
325 mg 30 minutes before niacin dosing to alleviate
flushing symptoms.
• If an extended-release preparation is used, increase the dose
of extended-release niacin from 500 mg to a maximum of
2,000 mg/day over 4-8 weeks, with the dose of extended-
release niacin increasing not more than weekly.
• If immediate-release niacin is chosen, start at a dose of
100 mg 3 times daily and up-titrate to
3 g/day, divided into 2 or 3 doses.
IIa C
Safety of Bile Acid Sequestrants (BAS)
1. BAS should not be used in individuals with baseline
fasting triglyceride levels ≥300 mg/dL or type III
hyperlipoproteinemia, because severe triglyceride elevations
might occur. (A fasting lipid panel should be obtained before
BAS is initiated, 3 months aer initiation, and every 6 to 12
months thereaer.)
III: Harm B
2. It is reasonable to use BAS with caution if baseline
triglyceride levels are 250-299 mg/dL, and evaluate a fasting
lipid panel in 4-6 weeks aer initiation. Discontinue the BAS
if triglycerides exceed 400 mg/dL.
IIa C
Safety of Cholesterol-Absorption Inhibitors
1. It is reasonable to obtain baseline hepatic transaminases
before initiating ezetimibe. When ezetimibe is
coadministered with a statin, monitor transaminase levels as
clinically indicated, and discontinue ezetimibe if persistent
ALT elevations ≥3 times ULN occur.
IIa B
