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2009 UpToDate

Dose, side effects, and drug interactions of lipid lowering drugs

Drug class

Dose

Dosing

Major side effects


and drug
interactions

Statins (HMG CoA reductase inhibitors)


Take with
Lovastatin

20-80

evening meal.

mg/day

BID if dose
>20 mg/day.

Pravastatin

Simvastatin

10-80

Take at

mg/day

bedtime.

Headache; nausea; sleep


disturbance; elevations in
hepatocellular enzymes
and alkaline phosphatase.
Myositis and
rhabdomyolysis, primarily
when given with

5-80

gemfibrozil or

mg/day

cyclosporine; myositis is
also seen with severe

20-80
mg/day
Fluvastatin
80 mg

renal insufficiency (CrCl


BID if dose

<30 mL/min). Lovastatin,

>40 mg/day.

atorvastatin, rosuvastatin,
and simvastatin potentiate

SR/day

effect of warfarin and all


Atorvastatin

Rosuvastatin

10-80

but rosuvastatin raise

mg/day

digoxin levels; these


interactions not seen with

5-40

pravastatin or fluvastatin.

mg/day

Potentiates warfarin action.


Gemfibrozil

600 mg BID

30 to 60 min

Absorption of gemfibrozil

before meals.

diminished by bile acid


sequestrants.

Nanocrystal
145 mg/day
Fenofibrate

Micronized
160-200
mg/day

Micronized
taken with
meals. Use
lower doses
with renal
insufficiency.

Skin rash, gastrointestinal


(nausea, bloating,
cramping) myalgia; lowers
blood cyclosporine levels;
potentially nephrotoxic in
cyclosporine treated
patients.

Given with
meals. Start
with 100 mg
BID and
titrate to 500
mg TID. After
Nicotinic acid

1-12 g/day

6 weeks,
check lipids,
glucose, liver
function, and
uric acid.
Increase dose

Prostaglandin-mediated
cutaneous flushing,
headache, warm
sensation, and pruritus;
hyperpigmentation
(particularly in
intertriginous regions);
acanthosis nigricans; dry
skin; nausea; vomiting;
diarrhea; and myositis.

as needed.
Bile acid sequestrants

Cholestyramine

Colestipol

4-24 g/day

5-30 g/day

Take within

Nausea, bloating,

30 min of a

cramping, and

meal. A

constipation; elevations in

double dose

hepatic transminases and

with dinner

alkaline phophatase.

produces

Impaired absorption of fat

same

soluble vitamins, digoxin,

lipid-lowering

warfarin, thiazides,

effect as BID

-blockers, thyroxine, and

dosing.

phenobarbital.

Take with
Colesevelam

3.75 g/day

meals QD or

Similar

divided BID
Cholesterol absorption inhibitors
Ezetimibe

10 mg/day

Increased transaminases
in combination with statins

Neomycin

1 g BID

Ototoxicity; nephrotoxicity
Loose stools; eosinophilia;

Probucol

500 mg BID

QT prolongation;
angioneurotic edema.

BID: twice daily; QD: daily; TID: three times daily; SR: sustained release;
CrCl: creatinine clearance.

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