Treatments

Additional medical treatments

Fibrates:
Fibrates are a group of medicines which include bezafibrate, fenofibrate and gemfibrozil. They inhibit the synthesis of cholesterol and bile acids, and enhance the secretion of cholesterol in bile.¹

Their main effect is to reduce triglycerides by reducing the concentration of very-low-density lipoproteins (VLDL): they also increase HDL-C and have variable effects on LDL-C. They are used mainly in patients with hypertriglyceridaemia
Fibrates have been shown to reduce the risk of coronary heart disease events in people with low HDL-C or with raised triglycerides

Side effects common with fibrates include gastrointestinal complaints, and fibrates appear to increase the likelihood of developing cholesterol gallstones.¹

Bile Acid Sequestrants (synthetic resins):
Bile acid sequestrants, also known as resins, are a group of medicines which include colestipol and colestyramine (also known as cholestyramine).¹

They act by binding bile, which is released from the gall bladder into the intestine to help digest foods. They prevent the re-absorption of bile acids back into the body, causing the body’s bile acid level to drop. The liver converts cholesterol to more bile acid to compensate, hence reducing LDL-C levels
Because bile acid sequestrants can also bind fat soluble vitamins and prevent their uptake by the body, it may be necessary to take a supplement of vitamin A, D and K whilst taking bile acid sequestrants
It is also recommended that any other medication is taken at least one hour before or 4–6 hours after taking bile acid sequestrants

These are sometimes prescribed in combination with a statin to increase cholesterol reduction. Sequestrant therapy may produce a variety of symptoms, including constipation, bloating, nausea, and gas.¹

Nicotinic Acid (Niacin):
Nicotinic acids, or niacin (the water-soluble B vitamin), are a group of medicines which include acipimox and nicotinic acid.¹

Nicotinic acid reduces triglycerides and increases HDL-C, and may also modestly reduce LDL-C. Nicotinates are mainly used in hypertriglyceridaemia.¹

Reference:
1. In: Fast Facts - Hyperlipidaemia. Eds Durrington P, Sniderman A. Health Press Ltd, Oxford, 2000. 81-94.