Drug Interactions of Lipid Lowering Drugs (Part 6):

Drug Interactions of Lomitapide:

More presentations from Naina Mohamed Pakkir Maideen
 

©   Lomitapide is an Orphan drug approved to reduce LDL cholesterol, total cholesterol, apolipoprotein B, and non-high-density lipoprotein (non-HDL) cholesterol in patients with Homozygous familial hypercholesterolemia (HoFH).

©   Mechanism of Action of Lomitapide:

©   Lomitapide may interact majorly with drugs such as CYP3A4 Inhibitors (Azole antifungals – Ketoconazole, Macrolide antibiotics – Clarithromycin, etc), Simvastatin or Lovastatin and Warfarin and Grapefruit Juice and Alcohol.

©   Lomitapide may also interact with Grapefruit Juice (GFJ) and Alcohol.

©   The concomitant use of Lomitapide and a CYP3A4 inhibitor such as (Azole antifungals – Ketoconazole, Macrolide antibiotics – Clarithromycin, etc), is contraindicated. 
©  Concomitant use of Lomitapide and Simvastatin or Lovastatin, warrants the monitoring of patients for the symptoms of myopathy.
© The INR of the patients receiving concurrent lomitapide and Warfarin therapy, should be monitored regularly and adjust warfarin dose accordingly.
© Patients receiving lomitapide should avoid the ingestion of Grapefruit juice (GFJ).
© The patients taking lomitapide should be instructed about the elevated risk of liver injury associated to Alcohol.

©   The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions.

©   The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the Doctor or Pharmacist.

©   The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.

Drug Interactions of Lipid Lowering Drugs (Part 5):

Drug Interactions of Ezetimibe:

More presentations from Naina Mohamed Pakkir Maideen

©   Ezetimibe is used as second line therapy to treat high LDL cholesterol levels in patients who are intolerant to statins or who are unable to achieve target with statins alone.

©   Mechanism of Action of Ezetimibe:

©   Ezetimibe can interact majorly with Fibrates (Gemfibrozil, Clofibrate, etc) and moderately with Bile acid sequestrants (Cholestyramine, Colestipol, Colesevelam), Warfarin and Cyclosporine.

©   Coadministration of Ezetimibe and a Fibrate except fenofibrate, is not recommended.

©   To minimize reductions in ezetimibe bioavailability, Ezetimibe should be administered at least two hours before or four hours after Bile acid sequestrants such as Cholestyramine, Colestipol and Colesevelam.

©   Frequent monitoring of Prothrombine Time or INR is recommended, if ezetimibe and warfarin are used concomitantly. Warfarin dosage should be adjusted accordingly.

©   Monitor for signs and symptoms of ezetimibe toxicity including abdominal, back or headache pain, fatigue, diarrhea, sinusitis, and cough when Ezetimibe and Cyclosporine are used concomitantly.

©   The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions.

©   The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the Doctor or Pharmacist.

©   The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.

Drug Interactions of Lipid Lowering Drugs (Part 4):

Drug Interactions of Niacin:

More presentations from Naina Mohamed Pakkir Maideen

©   Niacin is used to treat high cholesterol and Pellagra.

©   Mechanism of Action of Niacin:

©   Niacin can interact majorly with Statins (Simvastatin, Rosuvastatin, Atorvastatin, Lovastatin, etc) and moderately with Warfarin.

©   If coadministration of Niacin and Statins is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (Muscle pain, Tenderness, or weakness). Periodic creatine kinase (CK) determinations may be advisable.

©   More frequent monitoring of INR and/or prothrombin time is recommended, if concomitant therapy is required.

©   The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions.

©   The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the Doctor or Pharmacist.

©   The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.

Drug Interactions of Lipid Lowering Drugs (Part 3):

Drug Interactions of Bile Acid Sequestrants:

Drug Interactions of Bile acid sequestrants

More presentations from Naina Mohamed Pakkir Maideen

©   Bile Acid Sequestrants or Ion-exchange resins include Cholestyramine, Colestipol, and Colesevelam.

©   Bile Acid Sequestrants are used occasionally to treat Hyperlipidemia, as an adjunct to the statins. Bile acid sequestrants are also used as the principal therapy for bile acid-induced diarrhea.

©   Bile Acid Sequestrants interact majorly with drugs such as Deferasirox, Bezafibrate, Mycophenolate, etc.

©   Monitor serum ferritin levels and clinical response, when Bile acid sequestrants and Deferasirox are coadministered.

©   Separate the administration of Bezafibrate and Bile acid sequestrants by at least 2 hours.

©   It is recommended to avoid the coadministration of Bile acid sequestrants and Mycophenolate.

©   The patients are advised to take Pravastatin 1 hour before or 4 hours after Colesevelam.

©   The interaction between Colesevelam and Levothyroxine can be avoided by separating the administration of the two drugs by at least 4 hours.

©   The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions.

©   The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the Doctor or Pharmacist.

©   The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.

Drug Interactions of Lipid Lowering Drugs (Part 2):

Drug Interactions of Fibrates:

More presentations from Naina Mohamed Pakkir Maideen

©   Fibrates (Fibric acid derivatives) include Gemfibrozil, Clofibrate, Ciprofibrate, Fenofibrate and Bezafibrate.

©   Fibrates are used as the firstline drugs to treat primary hypertriglyceridemia.

©   Mechanism of Action of Fibrates:

Mechanism of action of Fibrates

©   It is contraindicated to use Ciprofibrate with other Fibrates and Gemfibrozil with Repaglinide, Simvastatin or Dasabuvir, concomitantly.

©   Fibrates can interact majorly with drugs such as Ezetimibe and Sulfonylurea Antidiabetics (Glyburide, Glipizide, Glimepiride, etc).

©   The major interactions of Gemfibrozil include Other Statins (Lovastatin, Atorvastatin, Fluvastatin, Pravastatin) and Colchicine.

©   The concomitant use of Fibrates and Ciprofibrate is contraindicated due to an increased risk of rhabdomyolysis and myoglobulinuria.

©   To avoid cholelithiasis, the coadministration of Ezetimibe and fibrates (except Fenofibrate), is not recommended.

©   Close monitoring of blood glucose is recommended, if Fibrates and Sulfonylurea Antidiabetics (Glyburide, Glipizide, Glimepiride, etc) are used concurrently.

©   Due to elevated risk of hypoglycemia, the combined use of Gemfibrozil and Repaglinide, is contraindicated.

©   The concomitant use of Gemfibrozil and Simvastatin may increase the risk of developing myopathy or rhabdomyolysis and is contraindicated.

©   Concomitant use of Dasabuvir and Gemfibrozil is contraindicated due to a 10-fold increase in dasabuvir exposure and an increased risk of QT prolongation.

©   The concomitant use of Gemfibrozil and Statins should be avoided, if possible.

©   Patients receiving Gemfibrozil and Colchicine should be monitored closely for signs and symptoms of myopathy or rhabdomyolysis.

©   Concomitant use of Fenofibrate and Anticoagulants,  requires the monitoring of INR value.

©   The interaction between Bezafibrate and Bile acid Sequestrants (Cholestyramine, Colestipol, Colesevelam)  can be avoided by separating the administration of the two drugs by at least 2 hours.

©   The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions.

©   The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

©   The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.