Selecting a Treatment Regimen Table 7A. Drugs Affecting Lipid Metabolism4, 21, 23
Drug Class, Agents and Daily Doses
HMG CoA reductase inhibitors ▶ Atorvastatin (10-80 mg) Lipitor® ▶ Fluvastatin (20-80 mg) Lescol® ▶ Lovastatin (20-80 mg) Mevacor®
▶ Pitavastatin (1-4 mg) Livalo® ▶ Pravastatin (20-40 mg) , generics
, generics
▶ Rosuvastatin (5-40 mg) Crestor® ▶ Simvastatin (10-40 mg) , generics
Pravachol® Zocor®
Bile acid sequestrants ▶ Cholestyramine (4-16 g) Questran®
▶ Colestipol (5-20 g) Colestid®
▶ Colesevelam (2.6-3.8 g) Welchol®
, generics , generics
Nicotinic acid ▶ Immediate release (crystalline nicotinic acid (1.5-3 g) Niacor®
▶ Extended release nicotinic acid (1-2 g) Niaspan®
, Nicolar®
▶ Sustained release nicotinic acid (1-2 g) Slo-Niacin®
Fibric acids ▶ Gemfibrozil (600 mg bid) Lopid®
▶ Fenofibrate (various doses) Antara®
, generics
▶ Clofibrate (1,000 mg bid) generics ▶ Fenofibric acid
Lipofen®, Fenoglide® Triglide® , Lofibra®
, generics Trilipix®
Ezetimibe ▶ Zetia®
Omega-3 ▶ Lovaza®
(EPA + DHA) (4 g) Fibricor® (35-135 mg), (35-105 mg)
LDL-C 15-20% LDL particle number 15-25% HDL-C 1-2% TG 10%
LDL-C Neutral or increase LDL-P Neutral to 3-5% (not significant in multiple trials). HDL-C Neutral to 10% HDL-P 2% TG 20-45% apoB 4-5%
▶ Vascepa™ (EPA) (4 g)
LDL-C Not increased LDL particle number 4-15% HDL-C Neutral TG 20-45% ApoB 8.5%
14
▶ Myalgia, rare ▶ LFT increase
, Tricor®
, Lipanthyl® ,
,
LDL-C 5-20% (may be increased in patients with high TG) LDL particle number 5-20% HDL-C 10-20% HDL-P 10% TG 20-50%
LDL-C 5-25% LDL particle number 10-25% HDL-C 15-35% HDL-P No change TG 20-45%
LDL-C 15-30% LDL particle number 15-30% HDL-C 3-5% TG No change or increase
▶ GI distress ▶ Constipation ▶ Decreased absorption of other drugs
▶ Flushing ▶ Hyperglycemia ▶ Hyperuricemia (or gout)
Lipid/Lipoprotein Effects
LDL-C 18-55% LDL particle number 18-55% HDL-C 5-15% TG 7-30%
Side Effects
▶ Myopathy ▶ May increase plasma glucose levels
▶ Upper GI distress ▶ Hepatotoxicity
▶ Dyspepsia ▶ Gallstones ▶ Myopathy ▶ Unexplained non-CHD deaths in WHO study using clofibrate
▶ Fishy taste ▶
▶ bleeding time which does not exceed normal limits
