Treating High Cholesterol

Types of Medications

Sometimes diet and exercise are not enough to control cholesterol. In that case, your doctor may prescribe a cholesterol-lowering drug. The important thing to remember is that you must continue to take the medication as directed by your doctor. If you stop taking the medicine, or stop eating a healthy diet and exercising, your cholesterol levels may increase.

The drugs most commonly used to lower cholesterol are:

Fibrates and Fenofibrates

Fibrates lower triglycerides and increase HDL cholesterol levels. Fibrates are effective in lowering blood triglyceride levels to prevent heart disease. By reducing the production of triglycerides and increasing HDL cholesterol, they can also reduce levels of LDL “bad” cholesterol. Fibrates are made up of two categories, fenofibrates and gemfibrozil.

Statins

Statins work in the liver to block production of cholesterol. Statins are very effective in lowering LDL cholesterol levels. Statins are generally safe for most people when used with proper medical monitoring.

Bile Acid Sequestrants

Bile acid sequestrants combine with bile acids in the intestine, which makes less cholesterol available to go into the bloodstream. These drugs are rarely prescribed by themselves to lower cholesterol. Your doctor may prescribe a bile acid sequestrant along with a statin.

Nicotinic Acid

Nicotinic acid lowers LDL cholesterol and triglycerides, and raises HDL cholesterol.

Other

New medications, like cholesterol absorption inhibitors, lower cholesterol by absorbing excess cholesterol in the intestine, which blocks its entry into the blood. For instance, ezetimibe is prescribed with a statin to help reduce the cholesterol that is absorbed from the digestive tract.

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With so many different kinds of medications available to fight high cholesterol, it is important to talk to your doctor about which would be right for you.

ANTARA® (fenofibrate capsules), a fibrate now available in a 130 mg capsule, provides powerful efficacy to reduce your “bad” cholesterol and increase your “good” cholesterol.
Learn more!

Satins and fibrates should not be used in combination unless the benefits outweigh the risks.

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Important Safety Information

ANTARA® (fenofibrate) capsules is contraindicated in patients with hypersensitivity to fenofibrate, in patients with hepatic or severe renal dysfunction including primary biliary cirrhosis, in patients with unexplained persistent liver function abnormality, and in patients with preexisting gallbladder disease.
Fenofibrate has been associated with increases in serum transaminases. Regular periodic monitoring of liver function should be performed, for duration of therapy, and therapy discontinued if enzyme levels persist above 3 times the normal limit.
There are no adequate and well-controlled studies in pregnant women. Fenofibrate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Improving glycemic control in diabetic patients showing fasting chylomicronemia will usually reduce fasting triglycerides and eliminate chylomicronemia thereby obviating the need for pharmacologic intervention. Markedly elevated levels of serum triglycerides (eg, >2000 mg/dL) may increase the risk of developing pancreatitis. ANTARA therapy on reducing this risk has not been studied.
Fenofibrate may increase cholesterol excretion into the bile, leading to cholelithiasis. If cholelithiasis is suspected, ANTARA therapy should be discontinued.
The combined use of ANTARA and HMG-CoA reductase inhibitors should be avoided unless the benefit of further alterations in lipid levels is likely to outweigh the increased risk. The combined use of fibric acid derivatives and HMG-CoA reductase inhibitors has been associated with rhabdomyolysis, markedly elevated creatine kinase levels, and myoglobinuria, leading to acute renal failure.
The use of fibrates alone including ANTARA, may occasionally be associated with myositis, myopathy, or rhabdomyolysis. Patients complaining of muscle pain, tenderness, or weakness should have prompt medical evaluation for myopathy. Discontinue ANTARA if myopathy or myositis is suspected or diagnosed.
The effect of ANTARA on coronary heart disease morbidity and mortality and noncardiovascular mortality has not been established.
Patients treated with other fibrate drugs experienced an increase in noncardiovascular and cardiovascular morbidity and mortality compared with placebo-treated patients.
Other precautions include pancreatitis, hypersensitivity reactions, and hematologic changes. Refer to full Prescribing Information for a complete list of precautions.
Caution should be exercised when coumarin anticoagulants are given in conjunction with ANTARA. The dosage of the anticoagulants should be reduced to maintain the prothrombin time/INR at the desired level to prevent bleeding complications. Frequent prothrombin time/INR determinations are advisable until it has been definitely determined that the prothrombin time/INR has stabilized.
Since bile acid sequestrants may bind other drugs given concurrently, patients should take ANTARA at least 1 hour before or 4–6 hours after a bile acid binding resin to avoid impeding its absorption.
Cyclosporine can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine. Because renal excretion is the primary elimination route of fibrate drugs including ANTARA, there is a risk that an interaction will lead to deterioration. The benefits and risks of using ANTARA with immunosuppressants and other potentially nephrotoxic agents should be carefully considered, and lowest effective dose employed.
Fenofibric acid is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection.
The most common (≥2% reported in clinical trials) side effects are: abnormal liver function test, including increased AST; increased ALT; CPK increase; respiratory disorder; abdominal pain; back pain; headache; diarrhea; nausea; rhinitis; asthenia; flu syndrome and constipation.

Please see full Prescribing Information.

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