738
P A R T 8
Drugs acting on the cardiovascular system
TABLE 47.3
DRUGS IN FOCUS Lipid-lowering drugs (continued)
Drug name
Dosage/route
Usual indications
HMG-CoA reductase inhibitors (continued)
pravastatin (Cholstat,
Pravachol)
10–40 mg/day PO taken at bedtime; start with
10 mg/day in elderly people and people with
hepatic or renal impairment
Children (8–13 years): 20 mg/day PO,
(14–18 years): 40 mg/day PO
Only statin with outcome data to show
effectiveness in decreasing CAD and
incidence of MI; prevents first MI even in
people who do not have a documented
increased cholesterol concentration (an
effect possibly related to blocking of
the formation of foam cells in injured
arteries); adjunctive therapy for reduction
of increased cholesterol and LDL
levels; approved for use with children
>8 years of age with genetically linked
hyperlipidaemia, as an adjunct to diet and
exercise
rosuvastatin (Crestor)
10 mg/day PO initial dose range; 5–40 mg/day
Adjunctive therapy for reduction of
increased cholesterol, LDL levels and
triglycerides; with diet to slow the
progression of atherosclerosis; raises
HDL slightly better than the other statins
and at a lower price
simvastatin (Simvar,
Zocor)
5–80 mg/day PO taken once a day in the
evening; start with 5 mg/day in elderly
people and in people with hepatic or renal
impairment
Children (10–17 years): 10 mg/day PO, up to
40 mg/day based on response
Prevention of first MI in people with
known hypercholesterolaemia and
CAD; adjunctive therapy for reduction
of increased cholesterol and LDL
levels; approved to lower cholesterol
levels in children 10–17 years of age
who meet specific criteria with genetic
hyperlipidaemias
Cholesterol absorption inhibitor
ezetimibe (Ezetrol)
10 mg/day PO
Adjunct to diet and exercise to reduce
cholesterol as monotherapy or combined
with an HMG-CoA inhibitor or a bile acid
sequestrant; adjunct to diet to reduce
elevated sitoterol and campesterol levels
in homozygous sitosterolaemia (to reduce
elevated sitosterol and campesterol
levels, the enzymes that are elevated
when people have this rare disorder);
used in combination with atorvastatin or
simvastatin as treatment for homozygous
familial hypercholesterolaemia
Other lipid-lowering agents
Fibrates
fenofibrate (Lipidil)
145 mg/day PO given with a meal; may be
increased up to 67 mg PO t.d.s. as needed;
monitor people with impaired renal function
and the elderly very carefully
Treatment of very high triglyceride levels
in adults who are at risk for pancreatitis if
not responsive to dietary measures
gemfibrozil (Jezil, Lipazil,
Lopid)
1200 mg/day PO divided into two doses and
taken before the morning and evening meals
Treatment of very high triglyceride levels
with abdominal pain and potential
pancreatitis in adults
Vitamin B
nicotinic acid (generic)
250 mg PO t.d.s. gradually increased to
3–4.5 mg/day PO
Treatment of hyperlipidaemia not
responding to diet and weight loss; to
slow progression of coronary artery
disease when combined with a bile acid
sequestrant
