Lipid Lowering Medications

Lipid Lowering Medications

Lipid Lowering Medications

Pharmacotherapy

1. HMG-CoA Reductase Inhibitors: Statins (Baseline liverfunctiontest)

   • Simvastatin, Fluvastatin, Lovastatin, Pravastatin, Atorvastatin, Rosuvastatin

2. Specific cholesterol absorption inhibitors: ezetimibe (small intestine, second line treatment)

3. Bile Acid binding (RESINS) - (not commonily used anymore due undesirable side effects)

   • Cholestyramine and Colestipol, Colesevelam.

4. Fibrates

   • Gemfibrozil, Clofibrate, Bezafibrate, and Fenofibrate, Ciprofibrate

5. Nicotinic Acid (NIACIN), Acipimox - (hot flushes side effects, give with aspirin to reduce that side effect)

6. Others: PCSK9 inhibitors

Effect of Lipid-modifying Therapies

• Therapy
  • TC
  • LDL
  • HDL
  • TG
  • Patient tolerability

Therapy	TC	LDL	HDL	TG	Patient Tolerability
Bile acid sequestrants (Resins)	↓ 7-10%	↓ 10-18%	↑ 3%	Neutral or ↑	Poor
Nicotinic acid (Niacin)	↓ 10-20%	↓ 10-20%	↑ 14-35%	↓ 30-50%	Poor to reasonable
Fibrates (gemfibrozil)	↓ 19%	↓ 4-21% or ▲	↑ 11-13%	↓ 30-60%	Good
Statins*	↓ 19-37%	↓ 25-60%	↓ 4-12%	↓ 14-29%	Good
Ezetimibe	↓ 13%	↑ 1%			Good
if its Statin benefit group ( independent of what lipid profile they give you Low HDL of hight Tag) u r going to give statin no other first line treatment on board.

Statin Therapy Guidelines

• High-Intensity Statin Therapy

  • Daily dose lowers LDL on average by ≥50%
    • Atorvastatin 40-80 mg
    • Rosuvastatin 20-40 mg

• Moderate-Intensity Statin Therapy

  • Daily dose lowers LDL on average by approximately 30-49%

    • Atorvastatin 10-20 mg

    • Rosuvastatin 5-10 mg

    • Simvastatin 20-40 mg

    • Pravastatin 40-80 mg

    • Lovastatin 40 mg

    • Fluvastatin XL 80 mg or Fluvastatin 40 mg BID

    • Pitavastatin 2-4 mg

• Low-Intensity Statin Therapy

  • Daily dose lowers LDL on average by <30%
    • Simvastatin 10 mg
    • Pravastatin 10-20 mg
    • Lovastatin 20 mg
    • Fluvastatin 20-40 mg

1. Doses of Statins Required to induce **** % Reduction of LDL-C*
2. ¨ Absolute responses in LDL-C to statin therapy depend on baseline LDL-C concentrations. ¨ More reliable indicator of statin efficacy is percentage reduction ¨ lowering of LDL-C levels of 1% gives approximate 1% reduction in the risk of ASCVD

Medication Overview

Simvastatin (Zocor)

• ZOCOR 40 mg
• 7 Tablets

Rosuvastatin (Crestor)

• CRESTOR 20 mg

Atorvastatin (Ator)

• ATOR Atorvastatin 20 mg
• 10 Tablets

Fluvastatin (Lescor XL)

• LESCOL XL Fluvastatin Sodium
• 80 mg
• 14 Tablets