the form of a powder (must be mixed with juice) or very large tablet. Commonly
prescribed resins include colestipol (Colestid) and cholestyramine (Questran).
(3) Fibrates. Fibrates are used primarily to treat high triglyceride levels.
They also increase HDL significantly and their effect on LDL varies. Side effects include
nausea, flatulence, abdominal pain, and diarrhea. While on this medication there is 2%
to 4% increase in the risk of developing gallstones. This medication should not be
taken with HMG CoA Enzyme Inhibitors as there is the potential for development of
severe muscle aches and weakness (myopathy). Fibrates include gemfibrozil (Lopid)
and fenofibrate (Tricor).
(4) Nicotinic Acid Derivatives (Niacin, vitamin B3). Nicotinic acid derivatives
are used for reducing high LDLs and triglycerides. They are also useful for treating low
HDL levels. As with fibrates, HMG CoA Reductase Inhibitors should be avoided as the
combination will lead to a serum increase of HMG CoA and myopathy. The classic side
effect of niacin is facial redness and flushing. Often aspirin is administered 30 minutes
prior to the niacin dose or niacin is initiated at low doses and gradually increased to
reduce this side effect. Other side effects include headache, gastrointestinal upset, and
dizziness. Only about 50-60% of patients can tolerate niacin because of its side effects.
Some other side effects other than those listed are itching, rashes, hepatotoxicity,
elevated glucose levels, and gout. Niacin is relatively contraindicated in diabetics,
patients with gout, and patients with peptic ulcer disease.