In a patient with poor glycemic control, hypertriglyceridemia, low HDL, which of the following drug Rx would be best without the risk of myositis as its side effect?
Correct Answer: Nicotinic acid
Description: Ans.B Nicotinic acidLIPID-LOWERING AGENTSDrugEffect on LDLEffect on HDLEffect on triglyceridesSide effects/problemsHMG-CoA reductase Inhibitors(Lovastatin, Simvastatin) pravastatin, Atorvastatin)|||||Expensive, reversible LFT's MyositisNiacin|||||Red, flushed fate, which is by aspirin or long-term useBile acid resins(cholestyramine)||?Slightly |Patients hate it-tastes bad and causes GI discomfortCholesterol absorption blocker (ezetimibe)|| -Rare | LFTs"Fibrates" (gemfibrozil, clofibrate, bezafibrate, fenofibrate)|||||Myosistis, | LFTsFenofibrate: Another 2nd generation prodrug fibric acid derivative which has greater HDL-CH raising and greater LDL- CH lowering action than other fibrates: may be more appropriate as an adjunctive drug in subjects with raised LDL-CH levels in addition to raised TG levels. No rise in LDL-CH has been observed in patients with high TG levels. Its t 1/2 is 20 hr. Adverse effects are myalgia, hepatitis, rashes. Cholelithiasis and rhabdomyolysis are rare. Fenofibrate appears to be the most suitable fibrate for combining with statins, because statin metabolism is minimally affected and enhancement of statin myopathy risk is lower. Indications of fenofibrate are similar to that of gemfibrozil. Gemfibrozil is the drug of choice for patients with markedly raised TG levels, whether or not CH levels are also raised. Episodes of acute pancreatitis are prevented in patients with chylomicro naemia and severe hypertriglyceridaemia. It is mo*t effective in type III hyperlipoproteinaemia; also a first line drug in type IV and type V disease.
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