Question: I have high triglycerides. I take statins and baby aspirin, but are there specific medications for triglycerides, and should I ask my doctor about them?
Dr. Hibberd's Answer:
Triglyceride elevation is also associated with adverse cardiac risk as well as increased risk for atherosclerosis and pancreatitis. Optimal fasting triglyceride levels are 150 or less. Levels over 300 are usually aggressively treated. The usual treatment is dietary modification and minimizing alcohol and fatty acid intake.
Niacin is well established as an effective triglyceride-lowering medication. Effective doses of Niacin are 1,500-3,000 milligrams, and are achieved by gradual increase of dose up to a maximum of 6 grams a day, which I have never seen, since most patients develop intolerance — flushing — at higher doses. Aspirin is a very effective reliever for this nuisance side effect of niacin.
Gemfibrizol (Lopid) has been used for many years but is variably effective and has been overshadowed by newer medications lately.
Newer medications such as fenofibrate (Tricor, etc.) and ezetimibe (Zetia) are very popular lately.
Discuss the side effects and drugs to avoid adverse combinations and to minimize side effects. Remember, grapefruit juice will greatly increase drug levels of many medications. Be sure your doctor is aware of all your medications and supplements, since there is considerable overlap and drug interaction data that may need to be considered.
Remember also that omega-3 supplementation will also affect your triglyceride levels.
Remember to periodically review your target values for LDL cholesterol, HDL cholesterol, and triglycerides. Be sure to periodically review your liver function tests while taking lipid medications.
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