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Suggested Drug Treatments for Lipid Abnormalities

for Health Care Providers

Table 3. Suggested Drug Treatments for Lipid Abnormalities

Back to Dyslipidemia Chapter

Lipid AbnormalityFirst ChoiceSecond ChoiceComments
* See PBM Criteria for Use for Ezetimibe.
Isolated high LDL, non-HDL cholesterolStatin
  • Niacin (time-release formulation)
  • Fibrate (reserve for patients intolerant of other agents who have high LDL, low HDL)
  • Ezetimibe (third choice)*
Be aware of possible statin-ARV interactions (see below and Lipid-Lowering Medications); use pravastatin, fluvastatin, rosuvastatin, or atorvastatin for most patients taking PIs

Patients taking PIs may have increased risk of myopathy

Start with low statin dosages

If incomplete response to statin, consider:

  • Increasing statin dosage
  • Switching to more potent statin (rosuvastatin or atorvastatin)
  • Adding niacin (time-release formulation)
  • Adding ezetimibe
  • Bile acid sequestrants in general should be avoided unless there are no other options; may interfere with absorption of ARVs and other medications
Ezetimibe should used as monotherapy only for patients unable to tolerate statins who do not respond to other agents

Avoid combining statin and fibrate: increased risk of myopathy

Triple therapy with statins, niacin, and ezetimibe is not recommended
Isolated high TGN-3 fatty acid

Niacin (time-release formulation)

Fibrate

Fibrates are most effective in lowering TG

If response is inadequate, add second agent

Atorvastatin may lower TG (as well as LDL)

High LDL + high TGStatin + N-3 fatty acid or niacin (time-release formulation)Fibrate Dual therapy likely to be most effective

Could start with single agent (eg, niacin) and add second agent if response is inadequate

Avoid combination of statin and fibrate: increased risk of myopathy

Isolated low HDLNiacin (time-release formulation)Fibrate Initiate CV exercise

From Dyslipidemia
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009