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Fibric Acid Derivatives

Fibric Acid Derivatives are drugs under the brand names Lopid (gemfibrozil) or Atromid-S (clofibrate) that enhance the body's ability to break down triglyceride rich lipid particles, and, as a result, effectively reduce triglyceride levels.

Uses
In patients with very high triglyceride levels, the reduction of triglycerides by these drugs can decrease the risk of inflammation of the pancreas, a very dangerous condition. In patients at risk for heart disease, these drugs have been shown to reduce the rate of development of heart attacks and coronary deaths.
 

Effects on Blood Lipids

  • Triglycerides are reduced 25 to 50 percent
  • HDL Cholesterol is increased 10 to 20 percent
  • Total cholesterol and LDL cholesterol are usually reduced 10 to 15 percent

    Adverse Reactions
  • Stomach discomfort and nausea
  • Skin rash
  • Abnormal liver enzyme tests
  • Muscle pains
  • Diarrhea
  • Makes the bile thicker and increases risk of gall bladder problems
  • Can potentiate the blood-thinning effect of warfarin (Coumadin)


Dosage
Consult your CCT physician about the appropriate times of day and quantities of this drug.  It is generally recommended to be taken slightly before or with meals. 


HMG-COA Reductase Inhibitors

These medications, packaged under the names Crestor, MevacorPravacholZocorLipitor or Lescol, block the production of cholesterol within cells, causing the cells to increase specific receptors on their surface that will take up LDL cholesterol particles from the blood. This effect is especially prominent in the liver, which is the organ that largely controls cholesterol in the body. As the number of LDL receptors increases, the levels of total and LDL cholesterol in the blood will go down.
 

Effects on Blood Lipids 

  • Total cholesterol and LDL cholesterol are reduced 15 to 40 percent 
  • Triglyceride levels may decline 10 to 15 percent
  • HDL cholesterol levels increase 5 to 10 percent


Taken with other medication, such as cholestyramine resin, has led to the reversal of coronary artery blockage in a substantial number of patients. 

Adverse Reactions

  • Temporary elevation of liver enzyme blood test has occurred in a small percentage of patients
  • Elevations of liver enzyme blood tests that are significant, doctor will discontinue treatment
  • Stomach discomfort
  • Muscle pains, unusual cramps or weakness
  • Skin rash


Drug Interaction
Consult with your CCT physician about taking HMG-CoA Reductase Inhibitors if you are taking cyclosporine, gemfibrozil, niacin, erythromycin or any other prescription medication, particularly those prescribed for cholesterol/lipid lowering purposes.

Dosage
Times and amounts vary by patient; consult your physician or pharmacist. Typically, the drug is taken in the evening with food for better absorption.


Niacin 

Also known as Vitamin B3, niacin is available in many generic and brand name formulations for use in lipid lowering applications.

Uses
Doses of niacin (1000 milligrams) significantly above the recommended daily requirement of 20 milligrams a day will decrease the liver's production of lipoprotein particles and can enhance the breakdown of these particles. A large study has shown that niacin may increase life expectancy in patients with coronary heart disease. Reversal of coronary artery disease has been achieved with the combination of niacin and bile acid binding resins. 

Effects on Blood Lipids

  • Triglycerides are reduced zero to 20 percent
  • HDL cholesterol is increased 10 to 25 percent
  • Total cholesterol and LDL cholesterol are reduced up to15 to 25 percent

Adverse Reactions

  • Flushing and itching (temporary, can be controlled with dosage adjustment)
  • Mild dryness of the skin 
  • Nausea
  • Indigestion
  • Diarrhea
  • Liver enzyme elevations 
  • Stomach ulcers ​
  • Gout
  • Arthritis
  • Increased blood sugar
  • Skin rash 
  • Certain heart rhythm disturbances
  • Liver inflammation 
  • Rapid drop in blood pressure
  • Schedule regular blood tests so your physician can monitor you for any side effects.

Dosage
Niacin should always be taken with some food in the stomach, and the same brand should be continually used to prevent flushing or diminished effect. Do not use niacinamide or nicotinamide as substitutes, as they have no lipid-lowering effects.

Do not use time-released niacin. 

Work with your physician to schedule the proper dosing schedule of niacin, which is typically taken several times a day for lipid-lowering purposes. Your CCT doctor will provide a specific schedule to you. This schedule will also tell you when you are to return for lab work.


Nitroglycerin Sublingual or Spray

Nitroglycerin sublingual (under the tongue) or spray is a commonly prescribed medication that relaxes blood vessels, widens coronary arteries and increases the supply of blood and oxygen to the heart. 

Uses 
It is used to relieve angina (chest pain), relieve smooth muscle pain that is not heart-related and may be used to prevent pain before strenuous exercise. To be taken when there is discomfort in the jaw, neck, shoulders, arm/hand; when there is chest pain/pressure; or for cold sweats, nausea or shortness of breath. 

Treatment 
Before treating with nitroglycerin, sit or lie down at the first indication of chest pain. Often, the pain will disappear with rest. If after five minutes the pain persists: 

Tablets

  • Place one nitroglycerin tablet under tongue
  • Wait three to five minutes
  • Repeat taking if pain/pressure is not completely relieved, taking one tablet every three to five minutes for a total of three tablets
  • If not completely relieved of pain, seek help. Continue taking the tablets every three to five minutes until help arrives, until you get to an emergency room or until you can contact your doctor
  • Relax 15 to 20 minutes after taking nitroglycerin to prevent dizziness or faintness
     

Spray

  • Do not shake container
  • Holding the container upright and close to the mouth, press the spray mechanism with your forefinger to release the spray onto or under your tongue; close your mouth immediately. Do not inhale or swallow the spray
  • Follow the same directions for after taking the tablet form

Adverse Reactions 
Headache, dizziness, lowered blood pressure, fast heart rate and/or hot, flush feeling. Generally, these reactions last only a few minutes. 

Storage

  • Keep in brown glass bottle
  • Refill prescription every three to six months
  • Do not store in the same bottle with other medications
  • Do not keep cotton in bottle; it absorbs nitroglycerin
  • Freshness decreases with time, heat, air and moisture