CMS Manual System - Louisiana Department of Health and Hospitals

Nitrates, e.g.,
Medication Issues and Concerns
isosorbide
mononitrate
isosorbide dinitrate
nitroglycerin
Cholesterol lowering
medications
HMG-CoA Reductase
Inhibitors (―statins‖), e.g.,
atorvastatin
fluvastatin
lovastatin
pravastatin
rosuvastatin
simvastatin
Adverse Consequences
May cause headaches, dizziness, lightheadedness,
faintness, or symptomatic orthostatic hypotension,
especially when initially started or when taken in
combination with antihypertensive medications
Monitoring
Liver function monitoring should be performed
consistent with manufacturer‘s recommendations,
generally accepted as:
o Prior to initiation of therapy, at 12 weeks
following both initiation of therapy and any
increase in dose, and periodically (e.g.,
semiannually) thereafter
Adverse Consequences
cholestyramine Interactions
fibrates, e.g.,
fenofibrate
clofibrate
May impair liver function; liver function tests
should be monitored as indicated above
May cause muscle pain, myopathy, and
rhabdomyolysis (breakdown of skeletal muscle)
that can precipitate kidney failure especially in
combination with other cholesterol lowering
medications.
May reduce the absorption of other medications
being taken concurrently. Other medications,
including diuretics, beta-blockers, corticosteroids,
thyroid hormones, digoxin, valproic acid,
NSAIDs, sulfonylureas, and warfarin should be
administered one hour before or four hours after
cholestyramine administration to avoid this
interaction
Adverse Consequences
May cause constipation, dyspepsia, nausea or
vomiting, abdominal pain
Monitoring
Fenofibrate and clofibrate require regular
monitoring of liver tests as well as evaluating the
complete blood count (CBC) prior to and after