On this podcast episode, I discuss fenofibrate pharmacology, adverse effects, kinetics, drug interactions, and much more!
Fenofibrate is typically only used for hypertriglyceridemia. The primary risk of hypertriglyceridemia is pancreatitis so we treat these levels because of this risk.
LFTs elevation has been associated with fenofibrate use as well as myopathy. In the presence of myopathy, checking CPK may be considered.
Fenofibrate is a weak CYP2C9 inhibitor. Warfarin and phenytoin are two important medications that may be affected by the use of fenofibrate.
On this podcast episode, I discuss niacin pharmacology, adverse effects, drug interactions, and much more.
Niacin has historically been used to manage lipids but has fallen out of favor due to adverse effects, and newer, more effective therapies being developed.
Niacin can elevate uric acid. Be sure to use this medication cautiously in patients with gout.
Flushing is one of the most common adverse effects of niacin. High doses, immediate-release formulations, and the use of alcohol can increase the risk.
On this episode, I breakdown pravastatin pharmacology, adverse effects, drug interactions and when you might see this drug used in practice.
Pravastatin is a statin and will lower LDL. Its use is a little limited in the fact that it is not as potent as other agents in its LDL lowering effects.
Pravastatin is hydrophilic which differentiates it from simvastatin, atorvastatin, and lovastatin.
I describe rhabdomyolysis in this podcast as it is a potential rare adverse effect of pravastatin.
On this episode, I discuss atorvastatin pharmacology, adverse effects, monitoring parameters, and drug interactions.
Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, the rate-limiting step in the production of cholesterol. It is used to prevent atherosclerotic cardiovascular diseases by decreasing cholesterol.
Atorvastatin is more lipophilic in comparison to other statins such as rosuvastatin. If a patient does not tolerate a statin, switching from a lipophilic to a hydrophilic or vice versa may decrease the chances of those side effects reoccurring.
It can be a high-intensity statin depending on the dose. 10-20mg is considered moderate and 40-80mg is classified as high intensity. Not all statins can reach high-intensity doses, which is why atorvastatin is so commonly used.
The FDA as of July 2021, has requested to remove the contraindication of pregnancy from the prescribing information. Here’s more information on that specific change and why it was requested. I’d encourage you to read it.
Atorvastatin is commonly found to have adherence issues so it should be taken whenever it is going to be best remembered by the patient.
Common adverse effects include myopathy, muscle pain, and soreness. Many elderly patients can be overlooked when they experience aches and pains, so it is important to take their medications into consideration. There are rare risks of liver injury and rhabdomyolysis. CPK and LFTs do not need to be regularly monitored if no symptoms are present.
Remind patients that their cholesterol will not be lowered right away. They will usually have their levels rechecked in 3-6 months.
Drugs that increase rhabdomyolysis risk when used concurrently include fibrates, red yeast rice, niacin, daptomycin. Monitor these patients closely for symptoms of muscle pain. Can also monitor CPK and decrease the dose of the statin in these patients. 3A4 interactions can increase the concentration of statins. These include clarithromycin, grapefruit juice, amiodarone, amantadine, and verapamil. 3A4 inducers can decrease the concentration of statins. These include St. John’s Wort and carbamazepine.
On this episode, I discuss ezetimibe pharmacology. Ezetimibe works by inhibiting Niemann-Pick C1-Like1 (NPC1L1) transporter. This transporter aids in cholesterol absorption so by blocking it, we can reduce cholesterol levels (and LDL) in the bloodstream.
Ezetimibe is usually very well tolerated. Diarrhea, myopathy, and elevations in LFT’s are adverse effects that have been reported but do not occur at high rates.
Ezetimibe is dosed at 10 mg once daily. This is a nice advantage because this is a starting dose and the usual treatment dose.
With the most recent cholesterol guideline updates, I do expect ezetimibe to be utilized a little more than it used to be. They place more emphasis on a target LDL and getting patients to goal.
Statins are going to be used first line for cholesterol and ezetimibe will be an add on therapy to consider. They don’t, unfortunately, lower cholesterol as much as high-intensity statins do.
