VIII. CHOLESTEROL-LOWERING DRUGS
2. Fenofibrate
Supplied; Tablets 100, 160 mg.
Dosage: 100–200 mg once daily with the main meal, maximum 100 mg in renal dysfunction.
3. Bezafibrate
Supplied: Tablets 200 mg.
Dosage: Mono formulation once daily in the evening.
E. Niacin (Nicotinic Acid)
This drug is not often used because of prominent side effects, which include flushing, itching, nausea, abdominal pain, diarrhea, jaundice, gout, palpitations, and increased blood sugar in diabetics. This drug should not be used if you have low blood pressure or have had a heart attack, heart failure, liver disease, a stomach ulcer, or diabetes. It is not advisable to combine niacin with statins because severe damage to muscles and the kidneys may occur.
F. Combination Therapy
The combination of simvastatin and ezetimibe has been shown in a clinical trial to be more effective than simvas-tatin alone. The combination caused LDL cholesterol reductions of 44–57% and HDL cholesterol increases of 8%–11%. Ezetimibe 10 mg plus simvastatin 10 mg and simvastatin 80 mg alone each caused a 44% reduction in LDL cholesterol. The combination was well tolerated with the safety profile similar to those of simvastatin and of placebo.
The combination of rosuvastatin and ezetimibe is advisable for severe hypercholesterolemia. This is the most powerful combination available for the reduction of elevated LDL cholesterol and is a welcome addition to the clinician’s armamentarium. Caution is required, how¬ever, because liver dysfunction or rhabdomyolysis may be precipitated at high doses of any statin, particularly if drug interaction occurs.