• Bile acid binding resins
    • Mechanism- interrupt enterohepatic circulation of bile acids
    • Not absorbed- so safe in children
    • Decreases LDL
    • GI side effects- constipation, abdominal pain
    • Increases triglycerides
    • Decreases absorption of other drugs
    • Cholestyramine, colestipol and colesevelam
  • Statins
    • HMGCoA reductase inhibition- prevents mevalonate formation
    • Inhibition of cellular cholesterol synthesis leads to enhanced LDL clearance from the plasma- decreased LDL
    • Increases HDL
    • Decreases plaque inflammation, decreases CRP
    • Enhances endothelial function
    • ADR- transaminase elevation, myositis
  • Cholesterol absorption inhibitors- ezetimibe
    • Decreases cholesterol and sitosterol absorption
    • Mechanism- Interferes with Niemann-Pick C1-like 1 protein 1 (NPC1L1)
    • Decreases LDL- used if statins alone are not enough to decrease LDL
    • Useful in sitosterolemia also
  • Fibrates
    • Bezafibrate, fenofibrate and gemfibrozil
    • Decrease triglycerides
    • Can increase LDL
    • Gemfibrozil can decrease statin elimination leading to myositis
    • Mechanism- interacts with PPAR-a
    • ADR- (EARSHOT)
      • Erectile dysfunction
      • Abdominal pain
      • Rash
      • Statin interaction
      • Homocysteine elevation
      • Oral anticoagulant interaction
      • Transaminase elevation
  • Nicotinic acid or niacin
    • Decreases triglycerides and increases HDL
    • Can slightly decrease LDL
    • ADR-
      • Hepatotoxicity
      • Hyperglycemia
      • Hyperuricemia
      • Flushing
      • Acanthosis nigricans
      • Gastritis
  • CETP inhibitor- torcetrapib
    • CETP- cholesterol ester transfer protein
    • Increases HDL
    • ADR-
      • Hepatotoxicity
      • Hypertension
      • Abdominal symptoms
    • Removed from trials now
  • Fish oils
    • Contains PUFA
    • Decreases triglycerides
    • Antithrombotic effect
  • Phytosterols
    • Interferes with cholesterol absorption
  • Probucol
    • Antioxidant effect also
    • Not used now as
      • Reduces HDL
      • Prolongs QT