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• Statins

  • Hydroxy methylglutaryl coenzyme (HMG CoA) reductase inhibitors
  • Reduces LDL & triglycerides (TG), raise HDL
  • Side effects: constipation, myopathy at higher doses, elevated liver enzymes
  • Contraindications: liver disease, accompanying use of cyclosporine, macrolides, various antifungals, cytochrome p-450 inhibitors
• Low-intensity statins

  • fluvastatin 20 mg per day
  • fluvastatin 40 mg per day
  • pravastatin 10 mg per day
  • pravastatin 20 mg per day
  • pravastatin 40 mg per day
  • simvastatin 10 mg per day
• Medium-intensity statins

  • fluvastatin 80 mg per day
  • simvastatin 20 mg per day
  • simvastatin 40 mg per day
  • atorvastatin 10 mg per day
  • rosuvastatin 5 mg per day
• High-intensity statins

  • simvastatin 80 mg per day
  • atorvastatin 20 mg per day
  • atorvastatin 40 mg per day
  • atorvastatin 80 mg per day
  • rosuvastatin 10 mg per day
  • rosuvastatin 20 mg per day
  • rosuvastatin 40 mg per day
• Bile acid sequestrants


  • Decreases LDL, minimal effects on HDL and TG which may actually rise
  • Side effects: GI distress, constipation, decrease absorption of other drugs
  • Contraindications: Raised triglycerides (TGs)

  
• Nicotinic acid (niacin)


  • Decrease LDL, and TGs; increases HDL
  • Side effects: Flushing, hyperglycemia, hyperuricemia, upper GI distress and hepatotoxicity
  • Contraindications: Absolute - chronic liver disease, severe gout, Relative - DM, peptic ulcer disease, hyperuricemia
• Fibrates


  • Decreases LDL and TGs; raises HDL
  • Side effects: Dyspepsia, gallstones, myopathy
  • Absolute contraindications: severe hepatic and severe renal disease
• Metabolic syndrome

  Any Three of the following: Central obesity, Triglycerides ≥ 150 mg/dl, HDL-cholesterol: men < 40mg/dl, women < 50mg/dl, BP ≥ 130/85mmHg, Fasting glucose ≥ 100mg/dl
• Treatment of elevated triglycerides

  • TG 150-200 mg\dl: Intensify weight management, Increase physical activity
  • TG 200-499 mg\dl: weight management, Increase physical activity, Add Niacin or fibrate
  • TG ≥500 :mg\dl: very low-fat diet, weight management and physical activity, fibrate or nicotinic acid