Anda di halaman 1dari 10

Treatment of Hypertrigliceridemia

Elevated TG
Risk factors ~ for LDL, HDL


Classification
Normal triglycerides : < 150 mg/dl.
Borderline-high triglycerides : 150 199 mg/dl.
High triglycerides : 200 499 mg/dl.
Very high triglycerides : 500 mg/dl.
TG > 150 mg/dl
Preponderance of small dense LDL
Diminished HDL


ANTI HYPERLIPIDEMIA
HMG CoA reductase inhibitors
statins LDL
Bile acid binding resin
cholestiramine
LDL
cholestipol
Nicotinic acid (Niacin) LDL
Probucol LDL
Fibric acids
clofibrat
TG
gemfibrozil
all type of hypercholesterolemia ( LDL)
HMG CoA reductase inhibitors
= statins
analog HMG CoA (precursor of cholesterol)
Lovastatin, simvastatin, pravastatin, fluvastatin, etc
MoA :
FK :
p.o first-pass extraction liver
Excretion : feces
Adverse effect :
Liver : LFT
Myopathy, rhabdomyolysis (with niacin / fibrate)

Therapeutic Uses :
Single dose, after evening meal
Effect : dose dependent
Lovastatin : 10-20 mg/day max 80 mg/day
Simva& pravastatin : 5-10 mg/day - max 40 mg/day
Fluvastatin : 20 mg/day - max 40 mg/day










p.o not absorbed feces
Anti pruritus
LDL 10-35%
cholestiramine, cholestipol
FK :
Adverse effect :
Local GIT disturbances : constipation, bloating
absorption of some drugs : T-S, HCT, digoxin, etc
Therapeutic Uses :
Powder contain + 4 gr of resin
Mixed with fluid / juice 30 mnts before after meal
dose gradually
Bile acid Binding Resins





p.o feces
Niacin
Water soluble vit B
VLDL & LDL ; HDL
FK :
Adverse effect :
Pruritus, flushing, nausea
Uric acid , hepatotoxic,
GI disturbances
Therapeutic Uses :
Tablet (100 mg), p.o, after meal
3 x 100 mg/day 1 week - dose gradually (2-3 gr/day)





lipophilic after meal
in adipose tissue for months
excretion : feces
Antioxidant atherosclerosis

LDL with of HDL
GI disturbances
Prolong QTc interval
Probucol
FK :
Adverse effect :
Therapeutic Uses :
tablet (500 mg), p.o, after meal, 2 x 1 tab/day
arrhythmia, post AMI
pregnancy
CI :








p.o after meal, protein-bound
excretion : urine
TG, but of LDL
Gallstone, GIT disturbances
Myositis, rhabdomyolysis
Fibric acid
FK :
Adverse effect :
Therapeutic Uses :
Gemfibrozil : 2x600 mg/day, p.o, after meal
Fenofibrate : 1x100 mg/day
LDL : + HMG CoA reductase inhibitor (!! Rhabdomyolysis)
renal / liver failure
pregnancy
CI :
Activate LP-lipase









Combination
statin & fibrate
Safe, effective
Small risk of myopathy
High
Cardiovascular risk
Choose !
Fenofibrate safer than Gemfibrozil
Drugs Affecting Lipoprotein Metabolism
Drug Class Lipid/Lipoprotein
Effects
Side Effects Contra-
indications
Clinical Trial
Results
HMG-CoA
reductase
inhibitors
(statins)
LDL 18%-55%
HDL 5%-15%
TG 7%-30%
Myopathy,
Increased liver
enzymes
Absolutes:
Active or
chronic liver
disease
Relative:
Concomitant
use of certain
drugs
Reduced major
coronary
events, CHD
deaths,need
for coronary
procedures,
stroke, and
total mortality
Fibric acids LDL 5%-20%
(may be increased
in patients with
high TG)
HDL 10%-20%
TG 20%-50%
Dyspepsia,
gallstones,
myopathy,
unexplained
non-CHD
death in
WHO study
Absolutes:
Severe renal
disease,
severe hepatic
disease
Reduced major
coronary
events

Anda mungkin juga menyukai