Cardiac Medications
Cholesterol and Lipid Lowering Drugs: Fibric Acid Derivatives
The fibric acid derivatives or Fibrates include:
Gemfibrozil (Lopid)
Fenofibrate (Lipidil micro, Lipidil Supra, Lipidil EZ)
Bezafibrate (Bezalip)
These agents act via a variety of mechanisms to lower triglycerides (35-50%)
levels and raise HDL levels (15-25%). They may also reduce Lp (a) and
fibrinogen, which have been identified as newer, non-traditional risk
factors. Fibrates are particularly useful in diabetic patients whose characteristic
lipid abnormality is high triglycerides and low HDL. In some patients
who have combined lipid abnormalities, Fibrates are combined with statins
to lower both triglycerides and LDL and to raise HDL. When combined it
is best to take the Fibrate in the morning and the Statin in the evening.
This minimizes the overlap of medication and the side effects. The fibrate
prevents the rise of triglycerides that occurs after eating and the statin
prevents the overnight production of cholesterol by the liver.
When combined, fibrates and statins may cause inflammation of skeletal
muscles resulting in muscle pain and weakness. This side effect is uncommon,
but serious and any generalized muscle pain symptoms should be reported
to your physician immediately.
Bile Acid Sequestrants (RESINS)
Bile acids are the breakdown products of cholesterol. They are excreted
by the liver via the bile. They are 90% reabsorbed from the intestine
and used to re-manufacture cholesterol in the liver. Bile Acid Sequestrants
(RESINS) interfere with this intestinal reabsorption, by binding the bile
acids in the gut and thus promoting their excretion from the body. These
agents are not absorbed and hence have no systemic effects. They may lower
the LDL cholesterol by 10-30% depending on the dose. The use of these
agents is often limited by GI side effects such as nausea, bloating cramping
and abnormal liver function.
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