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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