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Originally Posted by paco  Does anyone know if there are any guidline numbers for triglyceride when ezetrol should be added to statin therapy. NICE, as usual, keep things 'nice' and vague. |
Paco,
Typically, ezetimibe is not added to statin therapy for the purpose of tg reduction. It mainly works on total cholesterol and ldl cholesterol. You can obtain up to a 30% reduction in tg by statins themselves, so making sure the dose is maximized may help (if pt is candidate for higher dose). In addition, adding a fibrate such as fenofibrate (preferred vs gemfibrozil due to no drug-drug interactions) would be next choice if TG>500. The goal is to get them lower than 500 to reduce risk of pancreatitis. Optimally, they would be <150. Could also try slo release niacin which targets a tg reduction of up to 50% (as does the fibrates). If not a candidate for either, could try a concentrated dha fish oil which can get you a 40% reduction without the worry of liver enzyme elevation, added risk for rhabdomyolysis.