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Transcript
Table 1 Drug Starting Maximum Dose Dose Primary Side Effects Primary Contraindications Monitoring Comments Liver Disease, Pregnancy or lactation, use of Niacin or Gemfibrozil. Drug interaction with erythromycin and cyclosporine. LFTs, CPK, BUN creatinine, uric acid if symptoms Consistent with Myositis Avoid in females of childbearing age. If used, discontinue when pregnancy is contemplated. Well tolerated for mild hypercholesterolemia. Simvastatin is the most potent on a milligram basis. Flushing, nausea, hepatitis, gout exacerbation, worsened glucose control in diabetics DM, peptic ulcer disease, gout, liver disease, use of lovastatin/simvastatin LFTs, uric acid, glucose in appropriate clinical situations. Rx ASA 325 mg 30' before niacin, low starting dose and gradual increase in daily dose can all decrease flushing. Sustained release preparations may cause hepatitis. GI - constipation, bloating, gas Relatively contraindicated with increased triglycerides May need to adjust coadministered drugs Take other meds 1 hour before & 4-6 hrs after resin. Sour juices (e.g., grapefruit) may increase palatability. Can combine with any other antilipid drug class. Hepatitis, GI, rash, gallstones Lovastatin use, hepatic or severe renal dysfuction, gallstones LFTs Limit use to patients with severe hypertriglyceridemia. Not recommended for routine hypercholesterolemia. Interacts coumadin - increases PT. HMG CoA Reductase Inhibitors Fluvastatin 20 mg QD 40 mg QD GI Discomfort Pravastatin 10 mg QD 40 mg QD Hepatitis Lovastatin 10 mg QD 80 mg QD Myositis Simvastatin 10 mg QD 80 mg QD GI Discomfort Nicotinic Acid (Vitamin B3) Nicotinic Acid (Niacin) 250-500 mg BID however, lower dosages can be used 1 gm TID Bile Acid Sequestrants Cholestyramine 4 gm QD or (Questran, Questran BID Light) Colestipol (Colestid) 5 gm QD or BID 8 gm TID 10 gm TID Fibric Acid Derivatives Gemfibrozil (Lopid) 600 mg BID 600 mg BID Consult the appropriate prescribing references before using any of these drugs. Generally, in patients with elevated LDL cholesterol levels, HMG CoA inhibitors, nicotinic acid or resins can be used. For hypertriglyceridemia with or without LDL elevation nicotinic acid, gemfibrozil and in certain situations HGM CoA reductase inhibitors are useful.
