Step 7 Consider adding drug therapy if LDL exceeds levels shown in Step 5 table a Consider drug simultaneously with TLC for CHD and CHD equivalents a Consider adding drug to tlC after 3 months for other risk categories Drugs Affecting Lipoprotein Metabolism Drug Class Lipid/ Lipoprotein Side Effects Contraindications Daily doses Effects HMG CoA reductase Lovastatin (20-80 mg) LDL 18-55% Myopathy inhibitors(statins Pravastatin (20-40 mg) HDL T5-15' creased liver Active or chronic Simvastatin(20-80 mgl TO Fluvastatin [20-80 mg) Relative Atorvastatin 10-80 mgl · Concomitant use of 0.4.8m tertain drug Bile acid sequestrants Cholestyramine (4-16 g) LDL 15-30% Gastrointestinal Absolute (520 HDL个3-5% distress Colesevelam(2. 6-3. g) TG No change Constit Decreased absorp- TG >400 mg/dl Nicotinic acid Immediate release ↓5-25% Flushing Absolute (crystalline)nicotinic acid HDL T15-35% Hyperglycemia Chronic liver di 1.5-3 gml, extended ↓2050% Hyperuricemia Severe gout release nicotinic acid lor gout) Relative (Niaspan 1(1-2 g), Upper Gl distress sustained release Hyperuricemia nicotinic acid (1-2 g) ease Fibric acids Gemfibrozil lJ5-20% Absolute may be increased in Severe renal disease Fenofibrate(200 patients with high TG) Clofibrate HDL个1020% (1000 mg BIDI 2050% Cyclosporine, macrolide antibiotics, various anti-fungal agents, and cytochrome P-450 inhibitors(fibrates and niacin should be used with