Cardiac Medications
Cholesterol and Lipid Lowering Drugs:
Cholesterol Absorption Inhibitors
Cholesterol absorption inhibitors are a new class of cholesterol lowering
drugs which
block absorption of cholesterol at the brush border of the intestine without
affecting
absorption of triglycerides or fat soluble vitamins. These drugs have
the advantage
of not being systemically absorbed and can lower cholesterol by about
20% on their
own. When used in addition to statins they may provide an additional 15%
cholesterol
lowering. It is recommended to monitor liver function tests when using
a cholesterol
absorption inhibitor and a statin together. Side effects including fatigue,
abdominal
pain, diarrhea, muscle and joint pains and coughing are infrequent.
The only currently available cholesterol absorption inhibitor is ezetimibe
(Ezetrol“).
Health Canada has recently (Feb. 1, 2005) posted an Advisory
for Health Professionals and a Public
Advisory on ezetimibe (Ezetrol“) based on a letter from Merck
Frosst/Schering Pharmaceuticals highlighting important safety
information on ezetimibe (Ezetrol“). The product monograph has been
updated to include information from international post-marketing reports
of rare, and in some cases serious, adverse events.
Additional reports of myalgia (muscle pains), many accompanied by elevated
creatine phosphokinase (CK) values, have been reviewed by Health Canada.
The Warnings, Precautions, and Adverse Events sections are being updated
to reflect the occurrence of the following adverse events in patients
taking Ezetrol® (ezetimibe) alone or in combination with a statin:
- myalgia;
- rhabdomyolysis;
- hepatitis;
- acute pancreatitis;
- thrombocytopenia; and
- suspected interaction between Ezetrol“ (ezetimibe) and Warfarin
Patients should report to their prescribing physician any unexplained
symptoms after initiation of ezetimibe. including:
- dark urine;
- abdominal pain (especially if felt on the right side below the ribs);
- nausea or vomiting;
- yellowing of the skin or eyes;
- general itchiness; or pale stools
- ease of bruising
Liver function tests and CK muscle enzyme should be monitored in patients
on ezetimibe. Patients on Warfarin who begin ezetimibe should have their
INR monitored more closely.
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