Non-Statin Lipid–Lowering Drugs*
Non-Statin Lipid–Lowering Drugs*
Drugs | Adult Doses | Comments |
|---|---|---|
Adenosine triphosphate citrate lyase inhibitor | Lowers LDL-C | |
Bempedoic acid | 180 mg orally once a day | Risk of hyperuricemia, tendon rupture Especially useful in patients with statin-associated muscle adverse effects as the enzyme required to activate this drug is absent in the muscle |
Bile acid sequestrants | Lower LDL-C (primary), slightly increase HDL (secondary), may increase TGs | |
Cholestyramine | 4–8 g orally 1–3 times a day with meals | — |
Colesevelam | 2.4–4.4 g orally once a day with a meal | — |
Colestipol | 5–30 g orally once a day with a meal or divided with two or more meals | — |
Cholesterol absorption inhibitor | Lowers LDL-C (primary), minimally increases HDL-C | |
Ezetimibe | 10 mg orally once a day | — |
Drugs for homozygous familial hypercholesteremia | ||
Evinacumab | 15 mg/kg intravenous infusion once every 4 weeks | Given as an intravenous infusion over 60 minutes Adverse reactions in clinical trials include nasopharyngitis, influenza-like illness, and infusion reaction |
Lomitapide | 5–60 mg orally once a day | Risk of hepatotoxicity Increase dose gradually (about every 2 weeks) Measure transaminase levels before increasing dosage |
Fibrates | Lower TGs and VLDL, increase HDL, may increase LDL-C (in patients with high TGs) | |
Bezafibrate | 200 mg orally 3 times a day or 400 mg orally once a day | Decreased dose required in renal insufficiency Not available in US |
Ciprofibrate | 100–200 mg orally once a day | Not available in US |
Fenofibrate | 34–201 mg orally once a day | Decreased dose required in renal insufficiency May be safest fibrate for use with statins |
Gemfibrozil | 600 mg orally twice a day | Decreased dose required in renal insufficiency |
Nicotinic acid (niacin) | ||
Immediate-release: 500 mg orally twice a day–1000 mg orally 3 times a day Extended-release: 500–2000 mg orally once a day at bedtime | Increases HDL; lowers TGs (low doses), LDL-C (higher doses), and Lp(a) (secondary) Frequent adverse effects: Flushing, impaired glucose tolerance, increased uric acid Aspirin and administration with food minimize flushing | |
PCSK9 monoclonal antibodies | ||
Alirocumab | Primary hyperlipidemia: 75–150 mg subcutaneously every 2 weeks or 300 mg subcutaneously every 4 weeks Homozygous familial hypercholesterolemia: 150 mg subcutaneously once every 2 weeks | For patients with familial hypercholesterolemia and for other high-risk patients |
Evolocumab | Primary or mixed dyslipidemia: 140 mg subcutaneously every 2 weeks or 420 mg subcutaneously once a month Homozygous familial hypercholesterolemia: 420 mg subcutaneously once a month or 420 mg subcutaneously every 2 weeks | For patients with familial hypercholesterolemia and for other high-risk patients |
Prescription omega-3 fatty acids | ||
Eicosapentaenoic acid ethyl ester (EPA) + Docosahexaenoic acid (DHA) | 4 g orally once a day (4 capsules) | Lowers TGs Increases LDL |
Eicosapentaenoic acid ethyl ester (EPA) only | 4 g orally once a day (4 capsules) | Lowers TGs only |
* Many of these drugs are also available in combination with a statin. | ||
HDL = high-density lipoprotein; HDL-C = HDL cholesterol; LDL = low-density lipoprotein; LDL-C = LDL cholesterol; Lp(a) = lipoprotein (a); PCSK9 = proprotein convertase subtilisin-like/kexin type 9; TG = triglyceride; VLDL = very low-density lipoprotein. | ||