CHOLESTEROL LOWERING MEDICATIONS: NICOTINIC ACID AGENTS, FIBRATES AND PROBUCHOL
Nicotinic acid agents
Drug name and brand name: Niacin, nicotinic acid.
How do nicotinic acid agents work? Nicotinic acid is vitamin B3; a water soluble vitamin. When given in doses much higher than required for good health, niacin is able to lower LDL cholesterol and triglyceride levels, and raise HDL cholesterol levels. A typical starting dose is 250mg three times daily, which is usually increased up to a maximum daily dose of 3-4.5g. The Recommended Daily Intake (RDI) for niacin is only 13mg for women and 19mg for men. Nicotinic acid can lower LDL cholesterol by 10-20%, lower triglycerides by 20-50% and increase HDL cholesterol by 15-35%.
Side effects of nicotinic acid agents: The most common and annoying side effects are hot flushes, as it has the effect of dilating blood vessels. Clearly this is not the drug of choice for menopausal women! Digestive upsets such as nausea, indigestion, gas and diarrhea can occur. Nicotinic acid is contraindicated in people with peptic ulcers, as it can severely aggravate them. This drag can also enhance the effect of high blood pressure medication. Other problematic side effects include gout, an increase in blood sugar levels and inflammation of the liver.
Fibrates
How do fibrates work? The exact mechanism is not fully understood; however fibrates do lower triglyceride and VLDL levels, and can slightly increase HDL cholesterol levels. These drags come in tablet and capsule form, and are typically taken twice daily, half an hour before the morning and evening meals.
Side effects of fibrates: The most common problem is gastrointestinal discomfort, and these drugs can increase the chance of developing gallstones. Fibrates can increase the effects of some drags, making it more likely for you to suffer side effects from them; these drags include the blood thinning drag Warfarin, some diabetic medications and statin drags. If fibrates are taken together with statins, they greatly increase the chances of suffering severe side effects of statins such as myopathy (muscle pain), and rhabdomyolysis (the breakdown of muscle tissue). However, the Heart Foundation does recommend these two drags are combined in high risk people if one drag has not worked on its own. Regular blood tests for liver enzymes and creatine kinase (CK) are recommended if statins and fibrates are taken together to monitor side effects.
Probuchol
This is not a commonly used drag because it lowers both the LDL “bad” and HDL “good” cholesterol. Therefore, it is only used in some types of hereditary high cholesterol cases or in patients where other cholesterol lowering drugs have been ineffective. Probuchol can cause nausea, bloating, diarrhea and dizziness.
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