This document discusses lipid lowering therapy and summarizes different drug classes used to treat dyslipidemia. It outlines five main classes of lipid lowering agents: statins, fibrates, bile acid binding agents, cholesterol absorption inhibitors, and nicotinic acid and derivatives. Statins such as atorvastatin, simvastatin, and rosuvastatin are currently the first-line treatment for dyslipidemia as they are highly effective at lowering LDL and triglyceride levels while raising HDL. Common side effects of lipid lowering drugs include increased liver enzymes, muscle pains, and gastrointestinal issues like diarrhea and constipation.

1. VIGNAN
PHARMACY COLLEGE
By- kattaAmulya
13AB1T0014
5th
Pharm-D

2. Lipid Lowering
Therapy
By:- KattaAmulya.
2nd
Pharm-D
13AB1T0014
VIGNAN PHARMACY COLLEGE , Vadlamudi

3. Dyslipidaemia :-
Elivation of lipids in the blood
causes “hyperlipidemia”.
(or)
Abnormal amount of lipids (eg:-
fat & cholesterol ) in the blood
VIGNAN PHARMACY COLLEGE , Vadlamudi

4. Primary prevention
 Diet modifications
 Moderate amount of aerobic excercise ( walking ,
jagging , swimming , cycling )
It may be appropriate to give a trail of dietary &
lifestyle changes for 3-6 months
This rarely achieves the effect on the lipid profile &
drug therapy is required.
VIGNAN PHARMACY COLLEGE , Vadlamudi

5. Lipid Lowering
Therapy They are 5 main classes of lipid lowering
agents
Statins
Fibrates
Bile acid binding agents
Cholesterol absorption inhibitors
nicotinic acid & derivativesVIGNAN PHARMACY COLLEGE , Vadlamudi

6. Agents such as “soluble fiber & fish oil” have also
been used to reduce lipid levels
statins are currently the drug of choice in the
majority of patients with dyslipidaemia these
agents reduces “cardiovascular risk”
VIGNAN PHARMACY COLLEGE , Vadlamudi

7. Statins :-
Statins are singnificantly used in the treatment of
dyslipidaemia
Primary site of action is the Inhibition of HMG-
COA reductase in the liver & formation of
mevalonic acid is the rate limiting step
Statins are most effective at lowering LDL ,
TC , VLDL-C & raising HDL cholesterol
VIGNAN PHARMACY COLLEGE , Vadlamudi

8. Currently available statins are:-
 Atorvastatin
Fluvastatin
Lovastatin
Pravastatin
Rosuvastatin
Simvastatin
Statins are also found in the combination
medications like (lovastatin +niacin) ect..
VIGNAN PHARMACY COLLEGE , Vadlamudi

9. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND NAME STRENGHT
Atorvastatin Lipitor 10 - 80 mg
Fluvastatin Lescol 20 - 40 mg
Lovastatin Mevacor 10 - 40 mg
Pravastatin Pravachol 10 - 80 mg
Rosuvastatin Crestor 5 - 40 mg
simvastatin Zocor 5 – 80 mg

10.  Cerivastatin was with drawn from the
market in 2001 due to fatal Rhabdomyolysis
simvastatin is preferred because of its low cost ,
safety profile & Rosuvastatin is the most potent of
statin with impact on morbidity & mortality
Statins are generally preferred as first- line lipid-
lowering agents.
VIGNAN PHARMACY COLLEGE , Vadlamudi

11. Side effects
The most important adverse side effects are
 concentration of liver enzymes
 risk of diabetis
Muscle problems
Neuropathy
Pancreatic & hepatic dysfunction
Sexual dysfunctionVIGNAN PHARMACY COLLEGE , Vadlamudi

12. Fibrates :-
 This group include
 Benzafibrate
 ciprofibrate
 fenofibrate
 gemfibrozil
VIGNAN PHARMACY COLLEGE , Vadlamudi

13. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND
NAME
STRENGHT
Benzafibrate Benzalip 200mg
Ciprofibrate Cetaxin 100mg
Fenofibrate Tricor , lofibra 100mg
Gemfibrozil Lopid 600mg

14. Fibrates reduce Triglycerides & to a lesser extent,
LDL-C levels while increasing HDL-C
 Fibrates take 2-5 days to have a measurable effect
on VLDL-C
Fibrates have a beneficial effect on the fibrinolysis
& clotting mechanism.
Fibrates can be used first line in patients with severe
Hypertriglyceridaemia
VIGNAN PHARMACY COLLEGE , Vadlamudi

15. Side effects
The most important adverse side effects are
 Nausea
 Diarrhoea
 Abdomial pain
 muscle pains
 Unusual weakness
VIGNAN PHARMACY COLLEGE , Vadlamudi

16. Bile acid binding
agentsThe 3 members of this group in current use are
Colestyramine
Colestipol
colesevelam
VIGNAN PHARMACY COLLEGE , Vadlamudi

17. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND NAME STRENGHT
colestyramine Prevalite
questran
4g once or 2 a day
Colestipol Colestid 2g
colesevelam welchol 1875mg (3 Tablets )
orally twice a day ,
3750mg (6 tablets)
once a day with
meals.

18. Colestyramine & colestipol are considered as first
line agents
 colesevalam is the most recent bile acid binding
agent
 Hepatic enzyme 7-α-hydroxylase increases the
convertion of cholesterol to bile acids.
This increases LDL receptor activity in the liver &
removes LDL-C from blood.
VIGNAN PHARMACY COLLEGE , Vadlamudi

19. Side effects
The most important adverse side effects are
High doses
 Heart burn
 constipation
Long term use
They may interfere with the absorption of fat
soluble vitamins
VIGNAN PHARMACY COLLEGE , Vadlamudi

20. Cholesterol
absorption inhibitors Ezetimibe
 it can reduce LDL-C by 15-20%
 it can increase HDL levels & helps in reducing
triglycerides
 it should be prescribed either with a statin (or) a
fibrate (or) nicotinic acid witch lowers LDL-C
levels VIGNAN PHARMACY COLLEGE , Vadlamudi

21. VIGNAN PHARMACY COLLEGE , Vadlamudi
DRUG BRAND
NAME
STRENGHT
Ezetimibe Zetia 100mg , 3 times a
day
500mg orally once
a day at bed time

22. Nicotinic acid &
derivativesNicotinic acid lowers serum LDL-C ,TC, VLDL-
C , apolipoprotein B , Triglycerides & lp (a) &
increases HDL-C
Commonest side effect of nicotinic acid is
flushing.which is most prominent in the head ,
neck .
VIGNAN PHARMACY COLLEGE , Vadlamudi

23. Fish oil
Fish oil consists of Omega-3 fatty acid
 It increases HDL levels some times it
increases VLDLs in the also
Omega-3 fatty acids protect against CHD
mortality , particularly sudden death.
VIGNAN PHARMACY COLLEGE , Vadlamudi

24. Soluble fibre
Preparations containing soluble fibres , such as
Ispaghula husk has been shown to reduce lipid
levels
Fibre binds to bile acids in the gut & increase the
conversion of cholesterol to bile acids in the liver
VIGNAN PHARMACY COLLEGE , Vadlamudi

25. Referrence
 Clinical pharmacy & Therapeutics – Roger
& walker , churchill livingstone publications
 Wikipedia
VIGNAN PHARMACY COLLEGE , Vadlamudi

26. VIGNAN PHARMACY COLLEGE , Vadlamudi