Medications for High Triglycerides
by Phillip Treadwell, PharmD

Triglycerides are fats in the blood that are fairly responsive to changes in the diet. However, some people may have triglyceride problems that require drug therapy to correct. A few agents are available for this problem. They include fibrates, statins, niacin and fish oils. Each one of these medicines has distinct advantages and disadvantages. We will take a quick look at these products to discover the similarities and differences among them.

Fibratesinclude gemfibrozil (Lopid®) and fenofibrate (Tricor®). These are the best agents for lowering triglycerides in the blood, but may not help as much as some of the other agents for other cholesterol problems. Gemfibrozil is cheap, but fenofibrate is not. Fenofibrate is more potent than gemfibrozil for most people and fenofibrate can be taken once a day, while gemfibrozil must be taken twice a day. Both of these agents can cause severe interactions with some other cholesterol lowering drugs.

Statins(AKA: HMG COA reductase inhibitors) are excellent agents for lowering cholesterol. This class includes: simvastatin (Zocor®), pravastatin (Pravachol®), atorvastatin (Lipitor®), lovastatin (Mevacor®) and fluvastatin (Lescol®). These agents are only moderately effective for triglycerides, and may not work at all on really high triglyceride values. However, they are very effective for people with mildly elevated triglyceride levels and elevated LDL cholesterol levels. Many of these agents have studies that prove that they prolong survival in patients with or without proven heart disease. They can rarely cause muscle damage that can be painful, or even lead to kidney damage. Serious liver damage is another rare side effect of these agents.

Niacin is a good all around cholesterol lowering agent. It can lower triglycerides significantly (better than statins, less than fibrates), and improve LDL and HDL cholesterol. An important issue with niacin is product selection. High doses of sustained release niacin can cause severe liver damage in a large percentage of people taking it. Therefore, if you take niacin in high doses, (500mg per day or more), you should either select immediate release nicotinic acid (not niacinamide) or Niaspan®. Niaspan is a prescription product which is only available through your physician. Immediate release niacin is inexpensive, but must be taken three times per day. It can also cause an uncomfortable flushing sensation in most people who take it. Niaspan costs more but causes less flushing. Taking an aspirin 30 minutes before you take niacin can help with flushing symptoms. Niacin should not be used in high doses without the supervision of a physician.

Fish oils are an important source of omega-3 fatty acids. These “omega-3’s” can significantly lower triglyceride levels in some people. The typical dose is 300 mg to 1.2 grams per day. This is a natural alternative that seems to be well tolerated in the limited studies done thus far.

A lot of information is available about blood fat disorders. Diet is key to treating these problems. However, it is important to remember that many blood fat lowering drugs are proven to reduce the chance of having a stroke or a heart attack or of dying. Talk to your physician or pharmacist about the risks and benefits of these products before using any of them. Hopefully, you can use this information to get a conversation started with your healthcare professional that will lead to better health.