Dyslipidemia Drug Summary

Last updated: 14 May 2025

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Bile Acid Sequestrants

Content on this page:

Bile Acid Sequestrants

Bile Acid Sequestrants


Drug Available Preparation
 Dosage Remarks
Colesevelam 625 mg/tab

1,875 mg PO 12 hourly with meals or
3,750 mg PO 24 hourly in 1-2 divided doses with meals
Max dose:
4,375 mg/day
In combination with statin with or without Ezetimibe:
2-5-3.75 g PO 24 hourly

Adverse Reactions

  • GI effects (constipation, rarely cause fecal impaction, abdominal pain, bloating, flatulence)
Special Instructions
  • Administer other medications at least 1 hour before or 4 hours after bile acid sequestrants
  • To minimize GI effects start with low dose and increase slowly

   
  
 
Colestipol
 1 g/tab

2-16 g PO 24 hourly or in divided doses
Max dose: 16 g/day
5 g/packet bulk powder

5-30 g mixed in liquid PO 24 hourly or in divided doses
Max dose: 30 g/day
Colestyramine
(Cholestyramine) 		 4 g/packet bulk powder

4 g mixed in liquid PO 12 hourly
May increase to 8 g 12 hourly at intervals of not <4 weeks
Max dose: 24 g/day

Fibrates


Drug Dosage Remarks
Bezafibrate Regular-release:  200 mg PO 8-12 hourly
Extended-release: 400 mg PO 24 hourly
 Adverse Reactions
  • GI effects (anorexia, nausea, gastric discomfort); CNS effects (headache, vertigo); Other effects (fatigue, rash)
  • Myalgia, myopathy, rarely rhabdomyolysis: Occurs more often when combined with statins
Special Instructions
  • Not recommended in patients with severe renal or hepatic dysfunction, gallstones, hypoalbuminemic states
  • Use with caution in mild-moderate renal impairment
Ciprofibrate 100 mg PO 24 hourly
Choline fenofibrate Primary hyperlipidemia or mixed dyslipidemia
135 mg PO 24 hourly
Severe hypertriglyceridemia
Initial dose: 45-135 mg PO 24 hourly; may adjust dose at 4-8 weeks interval
Max dose: 135 mg PO 24 hourly
Co-administration with statins for mixed dyslipidemia
135 mg PO 24 hourly 		Adverse Reactions
  • GI effects (constipation, diarrhea, dyspepsia, increased ALT); CNS effects (headache, dizziness); Respiratory effects (sinusitis, nasopharyngitis, upper respiratory tract infection); Other effects (fatigue, arthralgia, back pain, muscle spasms, myalgia, pain in extremity)
Special Instructions
  • Contraindicated in patients with hepatic insufficiency (including biliary cirrhosis and unexplained persistent liver dysfunction), severe renal insufficiency, gallbladder disease, chronic or acute pancreatitis (except acute pancreatitis due to severe hypertriglyceridemia)
  • Use with caution when used concomitantly with statins
  • Monitor liver function regularly during therapy
  • Discontinue if liver enzyme levels persist >3x ULN
Fenofibrate
 Regular-release: 100 mg PO 8 hourly with meals or 200-300 mg PO 24 hourly with meals
Up to 400 mg/day PO in divided doses
Extended-release: 250 mg PO 24 hourly
Micronized: 160-268 mg PO 24 hourly or in divided doses
Nanotechnology formula:145 mg PO 24 hourly Suprabioavailable formula:160 mg PO 24 hourly
 Adverse Reactions
  • GI effects (abdominal pain, diarrhea, nausea, constipation, pancreatitis, elevated transaminase levels); Other effects (back pain, asthenia, rhinitis, elevated serum creatinine level)
Special Instructions
  • Not recommended in patients with hepatic or severe renal dysfunction, gallstones
  • Use with caution in mild-moderate renal impairment
  • Monitor serum transaminase levels regularly
Gemfibrozil   Regular release: 600 mg PO 12 hourly
Max dose: 1,500 mg/day
Extended-release: 900 mg PO 24 hourly in the evening
 Adverse Reactions
  • GI effects (abdominal pain, dyspepsia, nausea/vomiting); CNS effects (headache, drowsiness, dizziness, vertigo); Other effects (rash, gallstones, atrial fibrillation, eczema)
  • Myalgia, myopathy and rarely rhabdomyolysis: Occurs more often if combined with statins
Special Instructions
  • Not recommended in patients with severe renal or hepatic dysfunction, gallstones
  • Use with caution in mild-moderate renal impairment
  • Monitor serum transaminase levels regularly
Pemafibrate  0.1 mg PO 12 hourly
Max dose: 0.2 mg PO 12 hourly		 Adverse Reactions
  • Metabolic effects (increased blood creatine phosphokinase, uric acid, LDL-C, myoglobin, ALT, AST); Other effects (cholelithiasis, DM)
Special Instructions
  • Avoid in patients with severe renal or hepatic dysfunction, gallstones, on concomitant Cyclosporine or Rifampicin
  • Use with caution in patients with history of cholelithiasis or hepatic disorder
  • Monitor liver and renal function regularly, LDL-C levels during treatment

Fibrate/Statin


Drug Available Strength Dosage Remarks
Fenofibrate/
Atorvastatin		 Fenofibrate 160 mg/Atorvastatin 10 mg, Fenofibrate 160 mg/Atorvastatin 20 mg

Initially 1 tab PO 24 hourly
Max dose:
Fenofibrate 160 mg/Atorvastatin 40 mg

Adverse Reactions

  • CNS effects (headache, asthenia); GI effects (abdominal pain, nausea, constipation, diarrhea)
  • See Remarks section of each individual component for other adverse reactions
Special Instructions
  • Withhold use in patients with myopathy or a risk factor predisposing to renal failure from rhabdomyolysis
  • Perform LFTs before and after 12 weeks of treatment, periodic blood counts during 1st year of treatment
  • See Remarks section of each individual component for other special instructions
Fenofibrate/
Pravastatin		 Fenofibrate 160 mg/Pravastatin 40 mg

1 cap PO 24 hourly

Adverse Reactions

  • GI effects (abdominal distention and pain, discomfort; constipation, diarrhea, dry mouth, dyspepsia, eructation, flatulence, nausea/vomiting, increased transaminases)
Special Instructions
  • Should be taken with food and in the evening
  • Avoid in patients with severe hepatic or renal impairment, history of myopathy and/or rhabdomyolysis, phototoxic reaction during treatment with fibrates or Ketoprofen, gallbladder disease, chronic or acute pancreatitis, CPK elevation during previous statin treatment
  • Use with caution in patients with history of liver disease, pancreatitis, interstitial lung disease, pulmonary embolism, galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption
  • Routine monitoring of CPK, transaminases, liver and renal function every 3 months during the 1st year of treatment
Fenofibrate/
Rosuvastatin		 Fenofibrate 160 mg/Rosuvastatin 10 mg,
Fenofibrate 160 mg/Rosuvastatin 20 mg

1 tab PO 24 hourly after dinner

Adverse Reactions

  • GI effects (dyspepsia, flatulence, hepatitis, cholecystitis); CNS effects (fatigue, numbness, insomnia, dizziness); Other effects (photosensitivity, eczema, asthenia, flu syndrome, rhinitis, myalgia)
  • See Remarks section of each individual component for other adverse reactions
Special Instructions
  • Use with caution in patients with risk of myopathy, cholelithiasis, pancreatitis
  • See Remarks section of each individual component for other special instructions
Fenofibrate/
Simvastatin		 Fenofibrate 145 mg/Simvastatin 20 mg,
Fenofibrate 145 mg/Simvastatin 40 mg

1 tab PO 24 hourly

Adverse Reactions

  • Metabolic effects (increased ALT, increased blood creatinine); Other effects (upper respiratory tract infection, gastroenteritis, increased platelet count)
  • See Remarks section of each individual component for other adverse reactions
Special Instructions
  • Contraindicated in patients with chronic or acute pancreatitis with the exception of acute pancreatitis due to severe hypertriglyceridemia
  • Use with caution in patients with hepatic disorders, pancreatitis, mild renal insufficiency
  • See Remarks section of each individual component for other special instructions

Nicotinic Acide Derivatives


Drug Dosage Remarks
Acipimox 250 mg PO 8-12 hourly
Max dose: 1,250 mg/day 		Adverse Reactions
  • GI effects (heartburn, epigastric pain, nausea, diarrhea); CV effect (flushing); CNS effect (headache); Hypersensitivity reactions (itching, rash); Musculoskeletal effects (myalgia, arthralgia, myositis); Other effects (dry eyes, malaise)
Special Instructions
  • Not recommended in patients with peptic ulcer and severe renal impairment
  • Use with caution in patients with renal impairment
Nicotinic acid Regular-release:
100-200 mg PO 8 hourly
Extended-release:
Administered 24 hourly at bedtime
Week 1-4: 500 mg PO
Week 5-8: 1 g PO or
Week 1: 375 mg PO
Week 2: 500 mg PO
Week 3: 750 mg PO
Week 4-7: 1 g PO
Adjust dose according to response and tolerability every 4 weeks by not >500 mg/day
Maintenance: 1-2 g PO 24 hourly
Max dose: 2 g/day		 Adverse Reactions
  • CV effect (flushing); Metabolic effects (hyperglycemia, hyperuricemia, gout); GI effects (cramps, diarrhea, nausea); hepatotoxicity has occurred rarely
Special Instructions
  • To reduce flushing:
    • Take with food
    • Start with low dose and increase gradually
    • Administer enteric-coated Aspirin 75-325 mg PO prior to dose
  • Administer at bedtime
  • Not recommended in chronic liver disease and in patients with severe gout
  • Use with caution in patients with DM and in patients with hyperuricemia

Statins


Drug Dosage Remarks
Atorvastatin Initial dose: 10-20 mg PO 24 hourly any time of day
If a large reduction in LDL-C (>45%) is required: Start at 40 mg PO 24 hourly
Dose range: 10-80 mg PO 24 hourly
Primary hypercholesterolemia and mixed hyperlipidemia:
10-20 mg PO 24 hourly
Homozygous familial hypercholesterolemia:
Usually 10-80 mg PO 24 hourly
Heterozygous familial hypercholesterolemia:
Initially 10 mg PO 24 hourly
May be adjusted every 4 weeks to 40 mg/day		 Adverse Reactions
  • Musculoskeletal effects (myalgia, arthralgia, muscle cramps); GI effects (nausea, abdominal pain, constipation); Other effects (rash, headache, dizziness)
  • Myopathy has occurred and is usually associated with high dose, when statin is combined with Nicotinic acid or fibrate, in patients with renal or hepatic impairment, serious infections, hypothyroidism and advanced age
    • Rarely has rhabdomyolysis occurred
    • Advise patient to consult physician immediately if signs of muscle pain suggesting myopathy occur (especially if accompanied by fever and malaise)
Special Instructions
  • Dose should be based upon the individual’s lipoprotein profile
  • Increases in dose should be done at ≥4-week intervals based upon patient’s response until desired lipoprotein level is reached
  • Dose may need to be adjusted based on concomitant medications
  • Should not be used in patients with active liver disease and in those with unexplained transaminase elevations
  • Liver function should be tested before or after 6-12 weeks of therapy and with any dose increase
  • Use with caution in patients with renal impairment as the risk of myopathy is increased
  • Simvastatin: Due to increased risk of myopathy, including rhabdomyolysis, use of 80 mg dose of Simvastatin should be restricted to patients who have been taking this dose chronically (≥12 months) without evidence of muscle toxicity
Fluvastatin Initial dose: 20-40 mg PO 24 hourly in the evening
May increase to:
Regular-release: 40 mg PO 12 hourly or 80 mg PO 24 hourly in the evening
Extended-release: 80 mg PO 24 hourly
Lovastatin
Initial dose: 20 mg PO 24 hourly in the evening May increase to 80 mg PO 24 hourly in the evening or divided 12 hourly
Mild-moderate hypercholesterolemia:
Start with 10 mg PO 24 hourly in the evening
Dose range: 20-80 mg PO 24 hourly or in divided doses
Pitavastatin
 1-2 mg PO 24 hourly
May increase to max of 4 mg/day 
Pravastatin   Initial dose: 10-40 mg PO 24 hourly at bedtime
Dose range: 10-80 mg PO 24 hourly at bedtime  
Rosuvastatin  Initial dose: 5-10 mg PO 24 hourly; may increase to 20 mg PO 24 hourly after 4 weeks
Primary hypercholesterolemia (including heterozygous familial hypercholesterolemia), mixed dyslipidemia, dysbetalipoproteinemia, isolated hypertriglyceridemia and for slowing atherosclerosis progression:
Start with 10 mg PO 24 hourly
Homozygous familial hypercholesterolemia:
Start with 20 mg PO 24 hourly
Patient with severe hypercholesterolemia at high CV risk:
Up to 40 mg PO 24 hourly
In cases where doses >20 mg is indicated, initiation of therapy should be under close specialist supervision
Simvastatin
 Initial dose: 5-20 mg PO 24 hourly in the evening Dose range: 5-40 mg PO 24 hourly in the evening
Primary hypercholesterolemia, mixed dyslipidemia:10-20 mg PO 24 hourly at night, adjusted at 4 week interval
Dose range: 10-80 mg PO 24 hourly in the evening
Homozygous familial hypercholesterolemia:
40 mg PO 24 hourly in the evening or
80 mg/day PO in 3 divided doses of 20 mg, 20 mg and an evening dose of 40 mg

Other Agents

Drug Dosage Remarks
Benfluorex 150 mg PO 8 hourly
 Adverse Reactions
  • GI effects (loose stools, nausea/vomiting); CNS effect (drowsiness); Other effect (fatigue)
Special Instructions
  • Not recommended in patients with pancreatitis
Omega-3 fish oils1
(can be a combination of linolenic acid, DHA, EPA)
1-4 g/day PO in 2 divided doses
(of a preparation containing 46% EPA and 38% DHA) 		Adverse Reactions
  • GI effects (reflux, fish odor or taste, nausea/vomiting, diarrhea, constipation); rarely eczema and acne
  • Moderate elevation of transaminases has been reported in patients with hypertriglyceridemia
Special Instructions
  • Due to moderate increase in bleeding time (with high dosage), patients on anticoagulant therapy must be monitored and dosage of anticoagulant adjusted as necessary
Probucol
 500 mg PO 12 hourly
Adverse Reactions
  • GI effects (GI upset, diarrhea, flatulence, pain, nausea/vomiting); Hypersensitivity reaction (angioedema); CV effect (arrhythmias)
Special Instructions
  • Take with meals
  • Use with caution in patients with recent myocardial damage, history of arrhythmias, hypokalemia, prolonged QT interval or CV-associated syncope
Standardized red yeast rice 550-1,100 mg PO 24 hourly
Max dose:
1,100 mg PO 12 hourly
or
600-1,200 mg PO 12 hiurly
 Adverse Reactions
  • Mild GI upset (that can be alleviated if taken after meals)
Special Instructions
  • Administer after meals
  • Not recommended for use in individuals at risk for or having history of liver disease, and those who are <20 years of age
  • Concomitant use with other anti-lipid agents is not recommended
  • Avoid if >2 drinks of alcohol per day have been consumed
  • Use with caution in patients with serious infection, disease or physical disorder; in patients who have undergone organ transplant, recent major surgery
Tocopheryl nicotinate
(DL-alfa tocopheryl nicotinate)		 100-200 mg PO 8 hourly
 Adverse Reactions
  • GI effects (nausea, diarrhea, constipation, abdominal discomfort, anorexia); Other effects (flushing, edema, liver dysfunction)
 
Other Lipid Modifying Agents
Alirocumab
 75 mg SC every 2 weeks or
300 mg SC every 4 weeks
Max dose: 150 mg SC every 2 weeks 
Adverse Reactions
  • Respiratory effects (nasopharyngitis, bronchitis, sinusitis, cough); Musculoskeletal effects (myalgia, muscle spasms, musculoskeletal pain); Other effects (injection site reactions, UTI, flu, diarrhea, contusion)
Special Instructions
  • Avoid in patients with serious hypersensitivity to Alirocumab
  • If serious signs and symptoms of allergic reactions occur, discontinue therapy
  • Use with caution in patients with severe renal and hepatic impairment

Bempedoic acid
Heterozygous familial hypercholesterolemia:
180 mg PO 24 hourly
 Adverse Reactions
  • Metabolic effects (hyperuricemia, gout, increased liver enzymes, increased serum creatinine); CV effects (increased serum creatine kinase, atrial fibrillation); GI effects (abdominal pain, abdominal distress); GU effect (benign prostatic hyperplasia); Hematologic effects (leukopenia, anemia); Musculoskeletal effects (muscle spasm, limb pain, back pain, rupture of tendon); Respiratory effects (upper respiratory tract infection, bronchitis)
Special Instructions
  • Monitor for signs and symptoms of hyperuricemia and tendon rupture
Bempedoic acid/ Ezetimibe
 Heterozygous familial hypercholesterolemia:
Bempedoic acid 180 mg/Ezetimibe 10 mg
1 tab PO 24 hourly
 Adverse Reactions
  • Metabolic effects (hyperuricemia, increased liver enzymes); GI effects (abdominal pain, diarrhea); Hematologic effect (anemia); Musculoskeletal effects (muscle spasm, limb pain, back pain, arthralgia); Respiratory effects (upper respiraotry tract infection, bronchitis, sinusitis); Other effects (fatigue, influenza)
Special Instructions
  • Contraindicated in patients with known hypersensitivity to Ezetimibe
  • Monitor for signs and symptoms of hyperuricemia and tendon rupture
Evinacumab  Homozygous familial hypercholesterolemia:
15 mg/kg IV infusion over 60 minutes once monthly 		 Adverse Reactions
  • Respiratory effects (nasopharyngitis, rhinorrhea); Other effects (influenza-like illness, dizziness, nausea)
Special Instructions
  • Avoid in patients with history of serious hypersensitivity reactions to Evinacumab
  • If serious hypersensitivity reaction occurs, discontinue therapy
  • Advise patients who may become pregnant to use contraception during treatment and for at least 5 months following the last dose
Evolocumab
 Homozygous familial hypercholesterolemia:
420 mg SC once monthly
Primary hypercholesterolemia (heterozygous familial and non-familial), mixed dyslipidemia or adults with established clinical ASCVD:
140 mg SC every 2 weeks or
420 mg SC once monthly
Adverse Reactions
  • Homozygous familial hypercholesterolemia: Respiratory effects (upper respiratory tract infection, nasopharyngitis); Other effects (influenza, gastroenteritis)
  • Heterozygous familial hypercholesterolemia and primary hyperlipidemia: Respiratory effects (upper respiratory tract infection, nasopharyngitis, cough); GI effects (gastroenteritis, diarrhea); CNS effects (headache, dizziness); Other effects (influenza, back pain, injection site reactions, UTI, sinusitis, musculoskeletal pain, hypertension, allergic reactions)
Special Instructions
  • Avoid in patients with hypersensitivity to the medication
  • If serious signs and symptoms of allergic reactions occur, discontinue therapy
  • Use with caution in patients with moderate-severe hepatic or severe renal impairment

Icosapent ethyl
 2 g PO 12 hourly or 900 mg PO 12 hourly
Hypertriglyceridemia: 900 mg PO 8 hourly 		 Adverse Reactions
  • CV effects (peripheral edema, atrial fibrillation, atrial flutter); GI effects (constipation, abdominal distress); Musculoskeletal effects (arthralgia, musculoskeletal pain, limb pain): Other effects (hemorrhage, gout, oropharyngeal pain, increased serum TG)
Special Instructions
  • Must be taken with meals
  • Use with caution in patients with coagulopathy, known allergy or sensitivity to fish or shellfish
Inclisiran
 Initially 284 mg SC injection single dose, again at 3 months, followed by every 6 months
Adverse Reactions
  • Respiratory effects (dyspnea, bronchitis); Other effects (injection site reaction, pain in extremity, arthralgia, UTI, diarrhea)
Special Instructions
  • May be injected subcutaneously into the abdomen, upper arm, or thigh; injection should not be given into areas of active skin disease or injury
  • Hemodialysis should not be performed for at least 72 hours after Inclisiran dosing
  • Use with caution in patients with severe hepatic or renal impairment
Lomitapide
 Initial dose: 5 mg PO 24 hourly
May increase to 10 mg PO 24 hourly after ≥2 weeks of initiation, then additional 20 mg at 4-week interval up to 60 mg based on safety and tolerability
Max dose: 60 mg/day
 Adverse Reactions
  • GI effects (nausea/vomiting, dyspepsia, abdominal pain, hepatotoxicity, diarrhea); Other effects (chest pain, decreased weight, infections)
Special Instructions
  • Take at least 2 hours after evening meal
  • Contraindicated in patients taking CYP3A4 inhibitors and with moderate-severe hepatic impairment or active liver disease
  • May reduce absorption of fat-soluble vitamins and serum fatty acids
  • Perform LFTs prior to initiation and with any dose increase
 Phytosterol complex2 650 mg PO 12 hourly
 Special Instructions
  • Take with main meal
  • Use with caution in pregnancy and lactation; dose >3 g/day
1Combination products are available and some may contain antioxidants (eg tocopherol). Please see the latest MIMS for specific formulations and prescribing information.
2Combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

Peripheral Vasodilators & Cerebral Activators


Drug Dosage Remarks
Peripheral Vasodilator
Xantinol nicotinate
(Xanthinol nicotinate)		 Up to 3 g/day PO Adverse Reactions
  • Flushing, anxiety
Special Instructions
  • Avoid in patients with recent MI, decompensated cardiac insufficiency, acute hemorrhage
  • Use with caution in patients with active peptic ulcer, unstable hypertension

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated.
Not all products are available or approved for above use in all countries.
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information. 

Related MIMS Drugs