This document discusses lipid lowering therapy and summarizes different drug classes used to treat dyslipidemia. It outlines five main classes of lipid lowering agents: statins, fibrates, bile acid binding agents, cholesterol absorption inhibitors, and nicotinic acid and derivatives. Statins such as atorvastatin, simvastatin, and rosuvastatin are currently the first-line treatment for dyslipidemia as they are highly effective at lowering LDL and triglyceride levels while raising HDL. Common side effects of lipid lowering drugs include increased liver enzymes, muscle pains, and gastrointestinal issues like diarrhea and constipation.
3. Dyslipidaemia :-
Elivation of lipids in the blood
causes “hyperlipidemia”.
(or)
Abnormal amount of lipids (eg:-
fat & cholesterol ) in the blood
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4. Primary prevention
Diet modifications
Moderate amount of aerobic excercise ( walking ,
jagging , swimming , cycling )
It may be appropriate to give a trail of dietary &
lifestyle changes for 3-6 months
This rarely achieves the effect on the lipid profile &
drug therapy is required.
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5. Lipid Lowering
Therapy They are 5 main classes of lipid lowering
agents
Statins
Fibrates
Bile acid binding agents
Cholesterol absorption inhibitors
nicotinic acid & derivativesVIGNAN PHARMACY COLLEGE , Vadlamudi
6. Agents such as “soluble fiber & fish oil” have also
been used to reduce lipid levels
statins are currently the drug of choice in the
majority of patients with dyslipidaemia these
agents reduces “cardiovascular risk”
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7. Statins :-
Statins are singnificantly used in the treatment of
dyslipidaemia
Primary site of action is the Inhibition of HMG-
COA reductase in the liver & formation of
mevalonic acid is the rate limiting step
Statins are most effective at lowering LDL ,
TC , VLDL-C & raising HDL cholesterol
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8. Currently available statins are:-
Atorvastatin
Fluvastatin
Lovastatin
Pravastatin
Rosuvastatin
Simvastatin
Statins are also found in the combination
medications like (lovastatin +niacin) ect..
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10. Cerivastatin was with drawn from the
market in 2001 due to fatal Rhabdomyolysis
simvastatin is preferred because of its low cost ,
safety profile & Rosuvastatin is the most potent of
statin with impact on morbidity & mortality
Statins are generally preferred as first- line lipid-
lowering agents.
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11. Side effects
The most important adverse side effects are
concentration of liver enzymes
risk of diabetis
Muscle problems
Neuropathy
Pancreatic & hepatic dysfunction
Sexual dysfunctionVIGNAN PHARMACY COLLEGE , Vadlamudi
12. Fibrates :-
This group include
Benzafibrate
ciprofibrate
fenofibrate
gemfibrozil
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13. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND
NAME
STRENGHT
Benzafibrate Benzalip 200mg
Ciprofibrate Cetaxin 100mg
Fenofibrate Tricor , lofibra 100mg
Gemfibrozil Lopid 600mg
14. Fibrates reduce Triglycerides & to a lesser extent,
LDL-C levels while increasing HDL-C
Fibrates take 2-5 days to have a measurable effect
on VLDL-C
Fibrates have a beneficial effect on the fibrinolysis
& clotting mechanism.
Fibrates can be used first line in patients with severe
Hypertriglyceridaemia
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15. Side effects
The most important adverse side effects are
Nausea
Diarrhoea
Abdomial pain
muscle pains
Unusual weakness
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16. Bile acid binding
agentsThe 3 members of this group in current use are
Colestyramine
Colestipol
colesevelam
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17. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND NAME STRENGHT
colestyramine Prevalite
questran
4g once or 2 a day
Colestipol Colestid 2g
colesevelam welchol 1875mg (3 Tablets )
orally twice a day ,
3750mg (6 tablets)
once a day with
meals.
18. Colestyramine & colestipol are considered as first
line agents
colesevalam is the most recent bile acid binding
agent
Hepatic enzyme 7-α-hydroxylase increases the
convertion of cholesterol to bile acids.
This increases LDL receptor activity in the liver &
removes LDL-C from blood.
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19. Side effects
The most important adverse side effects are
High doses
Heart burn
constipation
Long term use
They may interfere with the absorption of fat
soluble vitamins
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20. Cholesterol
absorption inhibitors Ezetimibe
it can reduce LDL-C by 15-20%
it can increase HDL levels & helps in reducing
triglycerides
it should be prescribed either with a statin (or) a
fibrate (or) nicotinic acid witch lowers LDL-C
levels VIGNAN PHARMACY COLLEGE , Vadlamudi
21. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND
NAME
STRENGHT
Ezetimibe Zetia 100mg , 3 times a
day
500mg orally once
a day at bed time
22. Nicotinic acid &
derivativesNicotinic acid lowers serum LDL-C ,TC, VLDL-
C , apolipoprotein B , Triglycerides & lp (a) &
increases HDL-C
Commonest side effect of nicotinic acid is
flushing.which is most prominent in the head ,
neck .
VIGNAN PHARMACY COLLEGE , Vadlamudi
23. Fish oil
Fish oil consists of Omega-3 fatty acid
It increases HDL levels some times it
increases VLDLs in the also
Omega-3 fatty acids protect against CHD
mortality , particularly sudden death.
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24. Soluble fibre
Preparations containing soluble fibres , such as
Ispaghula husk has been shown to reduce lipid
levels
Fibre binds to bile acids in the gut & increase the
conversion of cholesterol to bile acids in the liver
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25. Referrence
Clinical pharmacy & Therapeutics – Roger
& walker , churchill livingstone publications
Wikipedia
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