|
|
 |
|
| •
|
Statins
are generally less effective for high triglycerides1 |
| •
|
Fibrates
can be added for further lowering of triglycerides: |
|
-
|
Gemfibrozil
(Lopid®) |
|
-
|
Fenofibrate
(Tricor®) |
| •
|
There
is increased risk of muscle and hepatic toxicity with combined
statin and fibrate therapy |
| •
|
Impact
of coinfection with HBV or HCV unknown2 |
•
Although effective for high cholesterol, the statins are less effective
for treating high triglycerides. As such, the fibrates represent first-line
drug therapy after diet and lifestyle changes are in place.1
• Patients can take gemfibrozil, 600 mg, 30 minutes prior to
their morning and evening meals. An alternative is micronized fenofibrate,
200 mg, once-a-day. If triglycerides remain high, or if LDL levels
remain elevated, a statin agent can be added cautiously.
• Although not well studied, significant drug interactions with
common HIV agents are not likely. However, combining fibrates with
statins can increase the risk of muscle and hepatic toxicity in these
patients.
• At present, the impact of coinfection with hepatitis B or C
viruses is unknown.2
References:
1. Dube MP, Sprecher D, Henry WK et al. Preliminary guidelines for
the evaluation and management of dyslipidemia in HIV-infected adults
receiving antiretroviral therapy. Recommendations of the adult ACTG
cardiovascular disease focus group. Clin Infect Dis. 2000;31:1216-24.
2. Tolman KG. Defining patient risks from expanded preventive therapies.
Am J Cardiol. 2000;85:15E-19E
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