Most effective triglyceride lowering agent

[katieb]

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First Aid says fibrates, but Boards & Wards Pharm says Niacin. Which is it?

 

[idq1i]

IIRC, niacin lowers vldl the most. I'm with FA on this one

 

[Samoa]

They're pretty equivalent at lowering triglycerides (30-60% TG decrease for both). But niacin lowers LDL more, and raises HDL more. So it's the preferred agent if the patient can tolerate it.

 

[Pox in a box]

They're pretty equivalent at lowering triglycerides (30-60% TG decrease for both). But niacin lowers LDL more, and raises HDL more. So it's the preferred agent if the patient can tolerate it.

Going to have to disagree with you though it's really a moot point.

Fibrates reduce TGs by 20-70%, decrease hepatic VLDL synthesis, and increase VLDL metabolism. Niacin reduces triglycerides by 20-50% and inhibits hepatic VLDL synthesis. Looking at side effect profiles, fibrates don't have the annoying itching that niacin has. To tell you the truth guys, you need more history and labs to make a fair treatment strategy. These subtle differences could help you in answering the question.

 

[dcpark74]

Going to have to disagree with you though it's really a moot point.

Fibrates reduce TGs by 20-70%, decrease hepatic VLDL synthesis, and increase VLDL metabolism. Niacin reduces triglycerides by 20-50% and inhibits hepatic VLDL synthesis. Looking at side effect profiles, fibrates don't have the annoying itching that niacin has. To tell you the truth guys, you need more history and labs to make a fair treatment strategy. These subtle differences could help you in answering the question.

Katzung says both are first line. oh well...i believe all sources. 🙂 BTW, it's niacin that has flushing as opposed to fibrates with rashes.

 

[Pox in a box]

Katzung says both are first line. oh well...i believe all sources. 🙂 BTW, it's niacin that has flushing as opposed to fibrates with rashes.

That's what I said.

 

[Samoa]

Going to have to disagree with you though it's really a moot point.

Fibrates reduce TGs by 20-70%, decrease hepatic VLDL synthesis, and increase VLDL metabolism. Niacin reduces triglycerides by 20-50% and inhibits hepatic VLDL synthesis. Looking at side effect profiles, fibrates don't have the annoying itching that niacin has. To tell you the truth guys, you need more history and labs to make a fair treatment strategy. These subtle differences could help you in answering the question.

The percentages quoted vary from source to source, and although everyone uses Katzung in medical school, it's not the best or most authoritative source on every issue. Seriously, you're perfectly capable of reading the literature and coming to your own conclusion about a drug. Don't take a piece of information as gospel just because the person who said it also wrote the book. Even the most knowledgeable person occasionally misjudges the data. So just make sure you've looked at the data yourself, and you agree with the conclusion.

Fibrates have side effects which are much more serious than the flushing niacin causes. It's not just rash, but also myositis, and rhabdomyolysis in combination with statins. But your patient is more likely to experience the benign but uncomfortable side effects of niacin than the infrequent but life-threatening side effects of fibrates. So adherence tends to be lower with niacin, and that's a legitimate consideration. But niacin's also much cheaper, and some forms are even OTC. Bottom line: there are many more things to consider than just the percentage of lipid-lowering. Although, all other things being equal, niacin's lipid-lowering profile is better than that of the fibrates. So, Katzung or no, I'd use niacin unless I had a reason to do otherwise.

But I can't imagine there'd be any kind of question on Step 1 where you'd have to choose between the two in a patient who only has elevated triglycerides. That's a little beyond the scope of what we're expected to know at this point.

 

[dcpark74]

The percentages quoted vary from source to source, and although everyone uses Katzung in medical school, it's not the best or most authoritative source on every issue. Seriously, you're perfectly capable of reading the literature and coming to your own conclusion about a drug. Don't take a piece of information as gospel just because the person who said it also wrote the book. Even the most knowledgeable person occasionally misjudges the data. So just make sure you've looked at the data yourself, and you agree with the conclusion.

Fibrates have side effects which are much more serious than the flushing niacin causes. It's not just rash, but also myositis, and rhabdomyolysis in combination with statins. But your patient is more likely to experience the benign but uncomfortable side effects of niacin than the infrequent but life-threatening side effects of fibrates. So adherence tends to be lower with niacin, and that's a legitimate consideration. But niacin's also much cheaper, and some forms are even OTC. Bottom line: there are many more things to consider than just the percentage of lipid-lowering. Although, all other things being equal, niacin's lipid-lowering profile is better than that of the fibrates. So, Katzung or no, I'd use niacin unless I had a reason to do otherwise.

But I can't imagine there'd be any kind of question on Step 1 where you'd have to choose between the two in a patient who only has elevated triglycerides. That's a little beyond the scope of what we're expected to know at this point.

you're right.

we use textbook sources now cuz we don't have time now to do research on drugs 😉 when we are not studying for boards we will be researching and formulating our own opinions.

fibrates are bad news for muscles as are statins as you said. statins themselves have myositis associated with them. that said, i agree with you on giving niacin over fibrates (also, fibrates cause gallstones...and do not elevate HDL or lower LDL as much as niacin.)

 

[Pox in a box]

The percentages quoted vary from source to source, and although everyone uses Katzung in medical school, it's not the best or most authoritative source on every issue. Seriously, you're perfectly capable of reading the literature and coming to your own conclusion about a drug. Don't take a piece of information as gospel just because the person who said it also wrote the book. Even the most knowledgeable person occasionally misjudges the data. So just make sure you've looked at the data yourself, and you agree with the conclusion.

Fibrates have side effects which are much more serious than the flushing niacin causes. It's not just rash, but also myositis, and rhabdomyolysis in combination with statins. But your patient is more likely to experience the benign but uncomfortable side effects of niacin than the infrequent but life-threatening side effects of fibrates. So adherence tends to be lower with niacin, and that's a legitimate consideration. But niacin's also much cheaper, and some forms are even OTC. Bottom line: there are many more things to consider than just the percentage of lipid-lowering. Although, all other things being equal, niacin's lipid-lowering profile is better than that of the fibrates. So, Katzung or no, I'd use niacin unless I had a reason to do otherwise.

But I can't imagine there'd be any kind of question on Step 1 where you'd have to choose between the two in a patient who only has elevated triglycerides. That's a little beyond the scope of what we're expected to know at this point.

Way to assume I used Katzung. Bro, there's no answer to this one.

 

[katieb]

Here's the question and answer, verbatim, from Pharm for the Boards & Wards:

a) cholestyramine
b) lovastatin
c) gemfibrozil
d) clofibrate
e) niacin

Which of the above drugs most effectively lowers triglyceride levels?

e) Niacin is the most effective reducer of serum triglyceride levels.

Not a big deal. Maybe by "effective," they mean "that also lowers LDL and elevates HDL." Perhaps the question is indeed more for the Wards than for the Boards.

 

[Shah_Patel_PT]

First Aid says fibrates, but Boards & Wards Pharm says Niacin. Which is it?

Is the DOC for familial hypertryglyceridemia ...cholysteryamine??? (i know the spelling is wrong)