Cholestrol Lowering Drugs. Know Everything, Choose what is best for you!

Cholesterol Lowering Drugs are also called Statins; these are used extensively for the lowering of bad cholesterol (LDL). You will note that their names end with the suffix –statin. These medications are used in combination with diet, exercise and other medications, in the US, Canada and Europe. In other countries, they may be marketed under different brand names. Nurses and medical students often have to be able to give advice to the patients regarding the statin which is being administered. In this brief article the following statins are discussed: a. Atorvastatin (Lipitor); b. Fluvastatin (Lescol); c. Lovastatin (Mevacor); d. Pravastatin (Pravachol); e.Rosuvastatin Calcium (Crestor); f. Simvastatin (Zocor).

Arterial diseases of the heart (CAD) and brain (CVA) killed between 12 and 15 thousand individuals in the US in 2003. This is according to statistics published by Center for health Statistics, Department of Health. Statins are a group of medications which are used to control blood cholesterol in an effort to reduce fatalities for arterial diseases. These two diseases are also the major killers in Australia.

Many different medications can be used to lower cholesterol. In some instances only one medication will be prescribed. In other situations, a combination of drugs may be prescribed. In addition to statins, resins and nicotinic acid (niacin), gemfibrozil and clofibrate are often prescribed.

1. Clofibrate also known a Atromid –S is a popular drug used for lowering the triglyceride level. The disadvantage of this medication is that it raises the High Density Lipids (HDL).

2. Gemfibrozil or Lopid is used to raise HDL levels.

3. Nicotinic Acid is another popular choice. This medication acts on the liver by influencing blood fats. It’s main role is to lower triglycerides and LDL cholesterol and to raise HDL cholesterol in patients.
Reminder: HDL is the good cholesterol and LDL is the bad cholesterol.

4. Resins are also referred to as bile acid-binding medications because they work by binding with bile-acids. This reaction takes place in the intestine by promoting increased disposal of cholesterol. Resins are of three types:
a. aCholestyramine (Questran, Prevalite, Lo-Cholset)
b. Colestipol (Colestid)
c. Colesvelam (WelChol)
5. Statins. I have seen and cared for many patients of statins. These are very effective in lowering the bad cholesterol (LDL). These work by preventing the formation of cholesterol from the circulating blood. Many statins are currently available. All of them begin to work immediately and do not have any currently known side effects.
a. Atorvastatin (Lipitor) Diet and exercise can lower cholesterol, however if that does not work then Lipitor may be prescribed. LIPITOR is proven to lower cholesterol and lower the risk of heart attack and stroke in people with multiple risks for heart disease including family history, high blood pressure, age, low HDL ("good" cholesterol), or smoking. For more details about risk factors see: http://www.quazen.com/Health/Nursing/Control-your-Blood-Pressure-with-or-without-medications.-Learn-how-and-choose-what-is-best-for-you.1189

Picture a: Atrovastatin (Lipitor) package and caplets.

b. Fluvastatin (Lescol) comes in capsule and ER tablet to be taken orally. This capsule should be taken with without food once a day at bedtime or twice a day. ER tablet is best taken once a day at HS (bedtime) with or without food. If taken, at the same time it becomes a habit and compliance improves. Patients should be advised to take the prescribed dose. Each ER tablet should be swallowed whole. (do not split, chew, or crush).

Picture b. Fluvastatin packaging and two capsules .

c. Lovastatin (Mevacor) High LDL cholesterol is usually first treated with exercise, weight loss in obese individuals, and a diet low in cholesterol and saturated fats. When these measures fail, cholesterol-lowering medications such as lovastatin can be added. The National Cholesterol Education Program (NCEP) has published treatment guidelines for use of these medications. These treatment guidelines take into account the level of LDL cholesterol as well as the presence of other risk factors such as diabetes, hypertension, cigarette smoking, low HDL cholesterol level, and family history of early coronary heart disease. The effectiveness of the medication in lowering cholesterol is dose- related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made. A reduction in LDL cholesterol level can be seen two weeks after starting therapy. May be taken on an empty or full stomach. The medication seems to be most effective when given with the evening meal.

Picture c. Lovastatin caplets and plastic containers.

Exercise caution in patients with alcohol or other liver diseases. Persistent abnormal liver tests during treatment are rare, but may need to be stopped if they are unusual. Muscle inflammation (myositis) and breakdown have been reported. Muscle breakdown causes release of muscle protein (myoglobin) into the blood and kidney tubules, resulting in renal failure. The risk of muscle breakdown is also increased when lovastatin is given together with other medications, such as cyclosporine (Sandimmune), nicotinic acid. Therefore, lovastatin should be used with caution and in lower doses when medications, such as cyclosporine are also needed. Lovastatin is not suitable for children. It is not habit addictive.
PREGNANCY: Lovastatin may cause foetal harm. Not to be given to pregnant women. Generally well- tolerated by most patients,
NURSING MOTHERS: Lovastatin should not be used by nursing mothers because of potential adverse side effects to the nursing infant. Side effects may include constipation and diarrhoea.