PHARMACOTHERAPY REVIEW CNS STIMULANTS for treatment of ...

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Table 6. (Continued)Niacin and Niacin CombinationsAgents Indicated to Treat HyperlipidemiasNiacin (Nicotinic Acid) --- Yes 100, 250, 500 TAB 2/dayNiacin (Nicotinic Acid) Niacor Yes 500 TAB 2-3/dayNiacin (Nicotinic Acid) Niaspan Yes 500, 750, 1000 TAB (ER) 1/dayNiacin (Nicotinic acid) --- Yes 125, 250, 400, 500 CAP (ER) 1/dayNiacin (ER)/ Lovastatin Advicor No 500/20, 750/20, 1000/20 CAP (ER) 1/dayMiscellaneous Agents (Cholesterol Absorption Inhibitor)Ezetimibe Zetia No 10 mg TAB 1/dayVII.DRUG INTERACTIONSMany drugs utilized to treat dyslipidemias interact adversely with a variety of other drugs in aclinically significant manner. The table below lists the most significant drug interactions with theantihyperlipidemic drugs relative to clinical severity.Bile Acid SequestrantsAnticoagulants (2)Corticosteroids (2)Digoxin (2)Furosemide (2)Levothyroxine (2)Statins (2)Valproic Acid (2)Fibric Acid DerivativesAnticoagulants (1)Statins (1)NiacinNo significance level (1) or (2) drug interactionsStatinsAtorvastatin (CYP3A4 metabolism)Azithromycin (1)Azole antifungals (1)Bile Acid Sequestrants (2)Clarithromycin (1)Clopidogrel (2)Cyclosporine (1)Diltiazem (2)Erythromycin (1)Gemfibrozil (1)9
Statins (continued)Grapefruit juice (2)Rifamycins (2)Verapamil (2)Fluvastatin (CYP2C9 metabolism)Anticoagulants (2)Bile Acid Sequestrants (2)Gemfibrozil (1)Rifamycins (2)Lovastatin (CYP3A4 metabolism)Antiarrhythmics (1)Anticoagulants (2)Azithromycin (1)Azole Antifungals (2)Bile Acid Sequestrants (2)Clarithromycin (1)Cyclosporine (1)Diltiazem (2)Disopyramide (1)Erythromycin (1)Gemfibrozil (1)Grapefruit juice (2)Rifamycins (2)Verapamil (2)Pravastatin (Sulfation)Azole antifungals (2)Bile Acid Sequestrants (2)Cyclosporine (1)Gemfibrozil (1)Simvastatin (CYP 3A4 metabolism)See lovastatinVIII.ADVERSE EFFECTSThe most prevalent adverse effects from the various antihyperlipidemic therapies have been reportedpreviously in this review. Less frequently occurring adverse effects are reported in package labeling.IX.SUMMARY/CONCLUSIONNCEP-ATP III guidelines address non-HDL as well as LDL treatment goals. Therefore, the properplace of bile acid sequestrants, fibric acid derivatives (fibrates), niacin and miscellaneous lipidlowering drugs and combinations of lipid lowering drugs should be considered for use along with thestatins.10
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