Lipid Lowering 6

HMG-COA Reductase Inhibitors (statins)

Indication

MOA

Major Contraindications

Black box warnings

ADRC

ADRR

Counseling points

Lipitor, Altoprev/Mevacor, Pravachol, Crestor, Zocor

Hyperlipidemia, familial hypercholesterolemia, primary/secondary prevention of atherosclerotic cardiovascular disease

Inhibit HMG COA to mevalonate

Breastfeeding / Liver disease

None

Myopathy / Diarrhea

Rhabdomyolysis/Hepatotoxicity

Lower LDL,TG, Raise HDL. Report muscle pain

Cholesterol Absorption Inhibitor

MOA

Major Contraindications

Black box warnings

ADRC

ADRR

Counseling points

Ezetimibe - Zetia

Hyperlipidemia, familial hypercholesterolemia

Inhibits absorption of cholesterol at brush border of small intestine

Gall Bladder, Severe hepatic dysfunction

None

None

Hepatotoxicity, rhabdomylosis

Lowers LDL, TG. Raise HDL. Report if muscle pain

Bile Acid Sequestrant

Indication

MOA

Major Contraindications

Black box warnings

ADRC

ADRR

Counseling points

Colesevelam - Welchol

Hyperlipidemia

Binds with bile acids in the intestine to form an insoluble complex that is elimated in the feces

Triglycerides > 500mg/DL, history of bowel obstruction, hypertriglyceridemia induced pancreatitis

None

Constipation

Pancreatitis, bowel obstruction

Lower Cholesterol levels, take with food. Packet - mix with 120-140 ml water stir and drink. tablets swallow with water

Fibric Acids

Indication

MOA

Major Contraindications

Black box warnings

ADRC

ADRR

Counseling points

Fenofibrate - Antara/Fenoglide + Gemfibrozil - Lopid

Hyperlipidemia, hypertriglyceridema

Activate PPARa - increases lipolysis and eliminates TG rich particles from plasma

Gall bladder

None

Increased transaminases

Hepatotoxicity, rhabdomyolysis(with statin)

Lowers LDL, TG. Raise HDL. Many forms- fenoglide with food. Doctor if muscle pain

Antilipemic

Indication

MOA

Major Contraindications

Black box warnings

ADRC

ADRR

Counseling points

Niacin - Niaspan

hyperlipidemia

Not well defined

Peptic ulcer disease, Severe hepatic dysfunction

None

Flushing, headache

Hepatotoxicity, Rhabdomylosis

Lower cholesteral lvls, titrate with low levels, flushing : avoid alcohol + spicy foods

Omega 3s

Indication

MOA

Major Contraindications

Black box warnings

ADRC

ADRR

Counseling points

Omega 3 Ethyl Esters - Lovaza

Hyperlipidemia, hypertrigluceridemia

Reduction in hepatic production of TG rich very low density lipoproteins

Hypersensitivity to drug, fish, shellfish

None

Diarrhea, fishy breath, burping, taste

Elevated LFT’s

Lower bad cholesterol, take with food