Drugs to Lower Lipids

Three new drugs for hyperlipidemia. Med Letter 2003;45(1151):17-19.

Ezetimibe (Zetia) is the first in a new class of drugs that inhibit intestinal absorption of cholesterol without the gastrointestinal effects of bile acid sequestrants. Taken with a statin, the recommended 10 mg of ezetimibe daily is more effective in lowering LDL cholesterol than doubling the dose of the statin. Ezetimibe and statin drugs may be taken simultaneously.

Extended-release lovastatin (Altocor), unlike immediate-release lovastatin, is best absorbed in the absence of food. It is less expensive than immediate-release lovastatin, has a similar side effect profile, and based on limited short-term data, is at least as effective in lowering serum lipids. Extended-release niacin plus immediate-release lovastatin (Advicor) markedly lowers LDL and triglycerides and raises HDL, but has a greater risk of myopathy than a statin alone. The fixed-dose combinations take away the flexibility of tailoring drug doses and are not recommended for initial therapy. The article includes a table that lists currently available cholesterol and triglyceride-lowering drugs along with their usual daily dose and retail cost.