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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)

 The drug choice depends on type of dyslipidemia to be treated:

➢ Hypercholesterolemia

➢ Hypertriglyceridemia (>500 mg/dL, related to elevated VLDL-C)
➢ Combined hypercholesterolemia and hypertriglyceridemia

➢ Metabolic syndrome
➢ Diabetic dyslipidemia

 Treatment of hypercholesterolemia

1- Drug of choice: statins

Intensity Effect
↓ LDL-C by about <30%
Low Intensity Ex: Simvastatin 10 mg Pravastatin 10-20 mg
Examples and classification Moderate Ex: Atorvastatin 10-20 mg, Rosuvastatin 5-10 mg

↓ LDL-C by about 30-50%

Intensity
Simvastatin 20-40 mg, Pravastatin 40-80 mg

High Intensity ↓ LDL-C by about ≥50%
Ex: Atorvastatin 40-80 mg Rosuvastatin 20-40 mg

 One daily dose reduces LDL-C by 25-60%
Dosage  each added daily dose causes reduction by 6%.
 Preferred to be administered at night
 Because cholesterol synthesis occurs predominantly at night
A) cholesterol-independent benefits (↓ing CHD risk) by:

Effects of statins ↓ing lipid peroxidation – ↑ing Nitric oxide synthesis,

↓ing c-reactive protein – Inhibit thrombosis
B) They cause slow benefits on ↓ing CHD risk:

by lowering lipids (↓ LDL-C, ↓ TGs by 7-40%, ↑ HDL-C by 5-15%)
➢ Elevated liver enzymes (monitor by LFTs every year)
Side effects of statin ➢ Risk of myopathy is increased when statins are combined with fibrates
➢ Myopathy (make CK (creatine kinase).

(especially gemfibrozil) or niacin > 1 g/day
➢ Rhabdomyolysis: indicated by muscle symptoms CK>10 times normal and
myoglobinuria (brown urine)

➢ May increase risk of diabetes by elevating HbA1c and blood sugar levels.

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