Symptom Finder - Treatment of Hypercholesterolemia
HYPERCHOLESTEROLEMIA
1. Look for the cause and treat: hypothyroidism, diabetes mellitus, nephrosis, biliary cirrhosis, etc.
2. If patient is overweight, the first thing to do is prescribe a reducing diet and an exercise program.
3. If weight is normal, prescribe a low cholesterol diet preferably with the help of a dietician. Reduce the fats to 30% or less of total calories and saturated fats to less than 10% of total calories. Cut fat off meat, restrict pork, gravy, and greasy foods and increase intake of fruits and vegetables. Restrict dairy products, egg yolks, bread, and pastries.
4. If above are unsuccessful, try a statin, such as atorvastatin (Lipitor): 10–80 mg daily.
5. Other statins may be tried
6. Goal is to get LDL below 130 mg/dL (or 100 mg/dL for diabetics).
7. If statins are unsuccessful, add ezetimibe (Zetia) 10 mg daily.
8. A bile acid sequestrant may be successful when above methods fail. Cholestyramine (Questran) may be given 4–24 g within 30 minutes of a meal: Other bile acid sequestrants are:
a. Colestipol (Colestid): 5–30 g/day.
b. Colesevelam (WelChol): 3.75 g once a day or in divided doses bid.
9. A fibrate such as gemfibrozil (Lopid) 600 mg bid or Fenofibrate
(TriCor) 160 mg daily may be tried next.
10. Finally, nicotinic acid (Niaspan): 1–6 grams daily in divided
doses. Titrate this up slowly because of flushing.
1. Look for the cause and treat: hypothyroidism, diabetes mellitus, nephrosis, biliary cirrhosis, etc.
2. If patient is overweight, the first thing to do is prescribe a reducing diet and an exercise program.
3. If weight is normal, prescribe a low cholesterol diet preferably with the help of a dietician. Reduce the fats to 30% or less of total calories and saturated fats to less than 10% of total calories. Cut fat off meat, restrict pork, gravy, and greasy foods and increase intake of fruits and vegetables. Restrict dairy products, egg yolks, bread, and pastries.
4. If above are unsuccessful, try a statin, such as atorvastatin (Lipitor): 10–80 mg daily.
5. Other statins may be tried
6. Goal is to get LDL below 130 mg/dL (or 100 mg/dL for diabetics).
7. If statins are unsuccessful, add ezetimibe (Zetia) 10 mg daily.
8. A bile acid sequestrant may be successful when above methods fail. Cholestyramine (Questran) may be given 4–24 g within 30 minutes of a meal: Other bile acid sequestrants are:
a. Colestipol (Colestid): 5–30 g/day.
b. Colesevelam (WelChol): 3.75 g once a day or in divided doses bid.
9. A fibrate such as gemfibrozil (Lopid) 600 mg bid or Fenofibrate
(TriCor) 160 mg daily may be tried next.
10. Finally, nicotinic acid (Niaspan): 1–6 grams daily in divided
doses. Titrate this up slowly because of flushing.