| DYSLIPIDAEMIA: MANAGEMENT |
| Principles: Higher LDL-c levels increase risk of CVD and reduction thereof reduces this risk; the reverse is true for HDL-c. Conversely, the CVD risk implications from higher than normal TG levels are less clear, as is the clinical benefit of treating moderate hypertriglyceridaemia; very high TG (>10 mmol/L or > 90mg/dL) may increase risk of pancreatitis although direct evidence is lacking. Diet, exercise, maintaining normal body weight and stopping smoking tends to improve dyslipidaemia; if not effective, consider change of ART and then consider lipid-lowering medication in high-risk patients (see p. 42). |
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| Drugs used to lower LDL-c |
| Drug class |
Drug |
Dose |
Side effects |
ADVISE ON USE OF STATIN TOGETHER WITH ART |
| Use with PI/r |
Use with NNRTI |
| Statin i |
Atorvastatin ii |
10-80 mg QD |
Gastrointestinal symptoms, headache, insomnia, rhabdomyolysis (rare) and toxic hepatitis |
Start with low dose v (max: 40 mg) |
Consider higher dose vi |
| Fluvastatin iii |
20-80 mg QD |
Consider higher dose vi |
Consider higher dose vi |
| Pravastatin iii |
20-80 mg QD |
Consider higher dose vi |
Consider higher dose vi |
| Rosuvastatin ii |
5-40 mg QD |
Start with low dose v (max: 20 mg) |
Start with low dose v |
| Simvastatin ii |
10-80 mg QD |
Contraindicated |
Consider higher dose vi |
| Cholesterol uptake↓ i |
Ezetimibe iv |
10 mg QD |
Gastrointestinal symptoms |
No known drug-drug interactions with ART |
|
| i |
A statin is preferred first-line therapy; different statins have variable intrinsic LDL-c lowering ability ii, iii, iv. Target levels for LDL-c: see p. 42. In persons where LDL-c targets are difficult to achieve, consult/refer to specialist. |
| ii, iii, iv |
Expected range of reductions of LDL-c: ii 1.5-2.5 mmol/L (60-100) mmol/L, iii 0.8-1.5 mmol/L (35-60 mg/dL),
iv 0.2-0.5 mmol/L (10-20 mg/dL) |
| v, vi |
The ART drug may v inhibit (statin toxicity, ↓ dose) or vi induce (=less effect of statin, ↑ dose gradually to achieve expected benefit ii, iii) the excretion of the statin. |
| vii |
Exception: If used with DRV/r, start with lower dose of pravastatin. |
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