Drugs to treat hypertriglyceridemia

Definition

Hypertriglyceridemia is a form of dyslipidemia: it is a pathology in which the serum triglyceride levels in an individual are much higher than the norm. In an adult man, one speaks of high triglycerides when their concentration in the blood is between 200 and 499 mg / dl; higher values refer to a condition of extreme gravity. Often hypertriglyceridemia is also associated with an exaggerated increase in bad cholesterol levels in the blood.

hypertriglyceridemia greatly increases the risk of cardiovascular diseases

Causes

There are numerous cases of familial hypertriglyceridemia, therefore dependent on a genetic defect: in this case, high triglycerides are not related in any way to hypercholesterolemia. The following are the other causes of hypertriglyceridemia: drug abuse (eg beta-blockers, corticosteroids, diuretics, estrogens, birth control pills, retinoids), alcoholism, carbohydrate-rich nutrition, diabetes mellitus, pregnancy, hypothyroidism, sedentary lifestyle, Cushing's syndrome, smoking.

Symptoms

Hypertriglyceridemia is often framed in the context of the metabolic syndrome, characterized by diabetes, hypertension and obesity, which exponentially increases the risk of contracting cardiovascular diseases, such as angina pectoris, atherosclerosis, coronary heart disease, heart attack and thrombosis.

Complications (triglycerides> 1000mg / dl): painful abdominal crises, acute pancreatitis, xanthoma

Diet and Nutrition

Information on Hypertriglyceridemia - Drugs for the Treatment of High Triglycerides is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hypertriglyceridemia - High Triglyceride Drugs.

drugs

The goal of treatment is the control of all those satellite pathological conditions associated with hypertriglyceridemia: as we have seen, often high triglycerides are also accompanied by an alteration in blood pressure and serum cholesterol values, from obesity, from the unbalanced diet and from a sedentary lifestyle. It is precisely from here that the cure must begin: the correction of predisposing factors, in fact, falls both between the rules of primary prevention of hypertriglyceridemia, and between the prophylactic measures to contain the cardiovascular risk. The people most at risk are those who have a genetic propensity to hypertriglyceridemia, those with a past history of heart attack, diabetics over 40, smokers and alcoholics.

Therefore, it is recommended to follow the rules dictated by food education, therefore not to exceed with sugars, not to consume too abundant meals, limit the consumption of lipids, chew slowly, prefer fish to meat, consume foods rich in antioxidants and practice a constant physical exercise.

To understand: but why should sugar (carbohydrates) be limited if the problem in question is the increase in triglycerides (fats)?

The exaggerated administration of simple sugars and carbohydrates in addition to 60% of the total daily energy favors the increase of triglycerides in the blood, since the sugars, having no effective storage system like lipids, reached the liver are transformed into triglycerides .

Drug therapy is often essential to maintain triglyceride levels within the physiological range; fibrates are the most commonly used drugs to treat familial hypertriglyceridemia, but statins (particularly indicated for lowering bad cholesterol levels in the blood), nicotinic acid derivatives, omega-3 acids and sequestrants are also effective. bile acids. To underline that it would be useless and unintelligent to follow a pharmacological treatment for hypertriglyceridemia in the absence of a healthy, balanced diet and sports.

Fibrates: drugs of choice for the treatment of hypertriglyceridemia, especially when triglycerides exceed the value of 885mg / dl. Fibrates can have variable therapeutic effects even on bad cholesterol levels. However, it is advisable to start the treatment first with a statin, then move on to treatment with fibrates (if the association is tolerated); clearly, in case of resistance to statins, it is recommended to choose a bundle. For patients with type 2 diabetes, hypercholesterolemia and hypertriglyceridemia, it is recommended to start therapy with a statin (for 6 months), subsequently associating a fibrate when triglyceride levels exceed 204mg / dl.

Fenofibrate (eg Lipsin, Fulcro, Fenolibs, Lipofen): the dosage plans to take an active dose of 200 mg (1 capsule), once a day; alternatively, take 3 capsules of 67 mg a day.
Gemfibrozil (eg LOPID, Genlip, Gemfibrozil DOC): for the treatment of hypertriglyceridemia, the normally recommended posology is 600 mg of active to be taken orally, divided equally into three daily doses, preferably 30 minutes before breakfast and dinner. Alternatively, take the long-lasting tablets: 400 mg, once a day, after meals.

Statins : although they are also used to reduce serum levels of triglycerides, statins are more often used in therapy to lower levels of bad cholesterol in the blood; however, they are also effective in the treatment of mild hypertriglyceridemia. These drugs exert their therapeutic activity through the inhibition of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, implicated in the synthesis of cholesterol in the liver. Statins prevent cardiovascular events and their associated mortality;

Atorvastatina (eg Totalip, Torvast, Xarator). In general, the initial dose varies from 10 to 40 mg per day, to be taken orally. Continue with this dosage for 2-4 weeks. The maintenance dose includes the intake of 10-80 mg of active per day. For children with familial hypertriglyceridemia, it is recommended to take 10 mg a day (max. 20 mg), possibly modulating the dose every 4 weeks, based on the subject's response to the cure.
Simvastatin (eg. Zocor, Simvastat, Omistat, Quibus, Setorilin). It is recommended to start the treatment with a dose of drug ranging from 10 to 20 mg, to be taken orally, once a day. The maintenance dose is expected to take 5-40 mg of active per day (once a day, in the evening). Sometimes the drug is formulated with other active ingredients, such as Sitagliptin (eg Juvisync), useful for combating diabetes in the context of hypercholesterolemia / hypertriglyceridemia, and Ezetimibe (eg Vytorin). For the treatment of familial hypertriglyceridemia, it is advisable to take a dose of 10 mg for children aged 10 to 17 years, possibly modulating the dose every 4 weeks. For children under the age of 5 with this problem, reduce the initial dose to 5 mg a day, and then gradually increase it to 10 mg / day, every 4 weeks. Do not exceed 20mg / day.
Pravastatin (eg. Selectin, Langiprav, Sanaprav). Indicatively, for the treatment of hypertriglyceridemia, take the drug at a dose of 10-40 mg, orally, once a day. For the maintenance dose, it is possible to take 40-80 mg of drug per day (the dose can be increased every 4 weeks). The pediatric dose for the treatment of familial hypertriglyceridemia suggests taking 20 mg of oral drug once a day for children aged between 8 and 13, while between 14 and 18 years, it is possible to increase the dose up to 40 mg, to be taken by mouth once a day.

Nicotinic acid derivatives : nicotinic acid, in monotherapy, is not widely used, due to its considerable side effects. However, at a dose of 1.5-3 mg per day, the drug inhibits the synthesis of triglycerides and cholesterol, thus lowering serum levels. The drug can be associated with a statin, in order to obtain better control over the lipid profile.

Acipomix (eg. Olbetam): it is a derivative of nicotinic acid, used in therapy for the treatment of hypertriglyceridemia, at a dose of 500-750 mg per day, evenly divided into several daily doses. The drug, although it causes fewer side effects than nicotinic acid, is also less effective. Consult your doctor.

Omega-3 acid compounds : this category includes both marine omega-3 triglycerides and the ethyl esters of omega-3 acids. They find indication for the care of:

Hypertriglyceridemia, as an alternative to fibrates
Hyperlipidemia in general, associated with a statin

The administration of omega-3 acid compounds is very useful to prevent complications (eg pancreatitis) deriving from hypertriglyceridemia (Triglycerides> 885mg / dl)

Omega-3 (eg Esapent, Seacor, Eskim): indicatively, take 4 grams of the drug a day, in a single dose or in two divided doses. For precise dosage: consult a doctor.

Bile acid sequestrants : indicated only in case of statin resistance in the context of hypertriglyceridemia. They are more suitable for the treatment of high cholesterol; Paradoxically, in some patients the administration of these drugs (as monotherapy) may even worsen hypertriglyceridemia. For this reason, only the drugs and pharmacological specialties belonging to this category are listed below, but not the dosage. Consult your doctor.