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ยาลดไขมันในเลือด

ภาวะไขมันสูงในเลือด คือ ภาวะที่มีระดับไขมันชนิดต่างๆในเลือดสูงมากจนเกินไป เช่น คอเลสเตอรอล ไตรกลีเซอไรด์

การมีไขมันในเลือดสูงทำให้ไขมันจับตามผนังหลอดเลือด เกิดภาวะหลอดเลือดตีบเปรียบเทียบให้เห็นภาพชัดเจนขึ้น คือเหมือนกับท่อระบายน้ำ ที่มีคราบตะกรันติดอยู่ ทำให้น้ำไหลยากขึ้น เมื่อปล่อยทิ้งไว้ ทำให้มีโอกาสเกิดภาวะความดันโลหิตสูง อวัยวะขาดเลือด ก่อให้เกิดโรคหลอดเลือดหัวใจตีบ เกิดอัมพฤกษ์ อัมพาต

 โรคไขมันในเลือดสูงได้ถูกตั้งสมญานามว่าเป็นนักฆ่าเงียบเช่นเดียวกับความดันโลหิตสูง เพราะจะไม่แสดงอาการจนกว่าร่างกายจะทนไม่ได้

จะรักษาไขมันในเลือดสูงเมื่อไขมันในเลือดสูงแค่ไหน

แนวทางการรักษาได้กำหนดไว้ดังนี้

  • Adults with a history of cardiovascular disease, including stroke, caused by atherosclerosis
  • Those with LDL-C level of greater than 190 mg/dL
  • Adults 40-75 years with diabetes
  • Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 5% to 19.9% 10-year risk of developing cardiovascular disease from atherosclerosis and risk-enhancing factors
  • Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 20% or greater 10-year risk of developing cardiovascular disease from atherosclerosis

Some people who don't fall into these categories may also benefit from statin therapy.

It's important to talk to your healthcare professional about your 10-year or lifetime risk. They will assess your risk factors to determine your level of risk and work with you to choose the best treatment.

View an interactive slideshow to see how cholesterol drugs work.

 

  • Statins. Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Statins can also help your body reabsorb cholesterol from built-up deposits on your artery walls, potentially reversing coronary artery disease.

    Choices include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

    ยากลุ่ม Statins

    เป็นยากลุ่มแรกที่แพทย์ใช้ลดไขมันเลวLDL ในเลือดนอกจากนั้นยังลดระดับไขมันไตร์กลีเซอร์ไรด์ triglycerides และยังเพิ่มระดับไขมันดี HDL ได้เล็กน้อยยากลุ่ม statin ได้แก่

     

    ผลการรักษาไขมันเลวสูงด้วยยากลุ่มนี้พบว่าสามารถลดการเกิดโรคหัวใจและหลอดเลือด

    ผลข้างเคียงของยากลุ่มนี้

    ยากลุ่มนี้อาจจะทำให้เกิดการอักเสบของตับ กล้ามเนื้อ น้ำตาลในเลือดสูง นอกจากนั้นยากลุ่มนี้ยังมีปฏิกิริยากับยาอีกหลายกลุ่มควรจะตรวจสอบก่อนการใช้ยา ระหว่างรับประทานยานี้ควรจะหลีกเลี่ยงส้มโอ

    ก่อนจะใช้ยา Statin หากท่านมีโรคหรือภาวะดังต่อไปนี้ต้องแจ้งให้แพทย์ทราบ

    • กำลังตั้งครรภ์ หรือมีแผลจะตั้งครรภ์ และกำลังให้นมบุตร
    • มีปัญหาเกี่ยวกับโรคตับ
    • มีปัญหากับปวดกล้ามเนื้อ
    • มีประวัติดื่มสุราเป็นประจำ
    • เป็นโรคไทรอยด์
    • เป็นโรคไต
    • แพ้ยายาชนิดนี้ หรือยาชนิดอื่น
    • กำลังรับประทานยาชนิดอื่นอยู่ ทั้งวิตามินและสมุนไพร

    ตารางแสดงประสิทธิภาพในการลดไขมันของยาแต่ละชนิด

    Atorva Fluva Pitava Lova Prava Rosuva Vytorin* Simva %↓ LDL-C
    ----- 40 mg 1 mg 20 mg 20 mg ----- ----- 10 mg 30%
    10 mg 80 mg 2 mg 40 or 80 mg 40 mg ----- ----- 20 mg 38%
    20 mg ----- 4 mg 80 mg 80 mg 5 mg 10/10 mg 40 mg 41%
    40 mg -----   ----- ----- 10 mg 10/20 mg 80 mg 47%
    80 mg -----   ----- ----- 20 mg 10/40 mg ----- 55%
      -----   ----- ----- 40 mg 10/80 mg ----- 63%

    Atorva=Atorvastatin; Fluva=Fluvastatin; Pitava=Pitavastatin; Lova=Lovastatin; Prava=Pravastatin; Rosuva=Rosuvastatin; Simva=Simvastatin.

    *No incremental benefit of Vytorin on cardiovascular morbidity and mortality over and above that demonstrated for simvastatin has been established.

     

  • Bile-acid-binding resins. 
  • ยากลุ่ม nicotinic acid และ analogue เช่น niacin , acipimox ยากลุ่มนี้สามารถลดไตรกลีเซอไรด์ได้ดี ลดคอเลสเตอรอลได้เล็กน้อยYour liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.ยากลุ่ม bile acid sequestrants เช่น cholestyramineยากลุ่มนี้ลดเพียงคอเลสเตอรอลอย่างเดียว

    Drugs that Work in Your Intestine

    What they are: Your doctor may call these “bile acid resin” drugs or “bile acid sequestrants.” The work inside your intestine. They attach to bile from the liver and prevent it from being absorbed back into your blood. Bile is made largely from cholesterol, so these drugs whittle down the body's supply of cholesterol.

    Examples include:

    A different type of drug, ezetimibe (Zetia), lowers bad LDL cholesterol by blocking cholesterol absorption in your small intestine. Studies have found that in people who have already had a heart attack, it can make a small cut in the risk of heart “events,” such as another heart attack, when you also take a statin.

    Side effects: For bile acid drugs, the most common side effects are constipationgas, and upset stomach. For ezetimibe, the most common ones include muscle or back paindiarrhea, and abdominal pain

  • Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.
  • Injectable medications. A newer class of drugs, known as PCSK9 inhibitors, can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.

    Protein Blockers: PCSK9 Inhibitors

    What they are: These drugs are used in people who can’t manage their cholesterol through lifestyle and statin treatments. They block a protein called PCSK9 to make it easier for the body to remove LDL from your blood.

    They are mainly used in adults who inherit a genetic condition called “heterozygous familial hypercholesterolemia” that makes it hard to bring down their cholesterol level, or for people who have heart disease and need more than a statin. You get them as a shot every 2 weeks.

    Examples:

    Side effects: Because these drugs are newer, it will take more time to get to know their side effects. In clinical trials, the most common ones for alirocumab are itching, swelling, pain, or bruising where you get the shot, as well as colds and flu. For evolucumab, they include colds, flu, back pain, and skin reactions where you get the shot.

Niacin

What it is: This B-vitamin, also known as nicotinic acid, is found in food but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol.

Examples include:

Research has not shown that adding niacin, when you already take a statin, further lowers your risk of heart disease.

Side effects: The main ones are flushing, itching, tingling, and headache.

Targeted Therapy - ATP Citrate Lyase (ACL) Inhibitors

What it is: Bempedoic (Nexletol) keeps your liver from processing cholesterol. It is designed to help lower LDL in adults who have a genetic condition called heterozygous familial hypercholesterolemia (HeFH), which causes those who have it to have high cholesterol. It can also help lower the LDL in people with atherosclerotic cardiovascular disease (ASCVD).

Examples include: Bempedoic (Nexletol) 

Side effects: Upper respiratory tract infection, muscle spasms, excess of uric acid in the blood, back pain, abdominal pain or discomfort, bronchitis, anemia, and elevated liver enzymes. 

Medications for high triglycerides

If you also have high triglycerides, your doctor might prescribe:

  • Fibrates. The medications fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid) reduce your liver's production of very-low-density lipoprotein (VLDL) cholesterol and speed the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.

    Using fibrates with a stain can increase the risk of statin side effects.

  • Niacin. Niacin limits your liver's ability to produce LDL and VLDL cholesterol. But niacin doesn't provide additional benefits over statins. Niacin has also been linked to liver damage and strokes, so most doctors now recommend it only for people who can't take statins.
  • Omega-3 fatty acid supplements. Omega-3 fatty acid supplements can help lower your triglycerides. They are available by prescription or over-the-counter.

    If you choose to take over-the-counter supplements, get your doctor's OK. Omega-3 fatty acid supplements could affect other medications you're taking.

 

 

ยาที่ใช้ในภาวะไขมันในเลือดสูง

โดยทั่วไปแพทย์จะแนะนำให้ผู้ป่วยที่เริ่มมีภาวะไขมันในเลือดสูงควบคุมอาหาร ออกกำลังกาย และลดหรือหยุดสูบบุหรี่ หากทำตามที่แพทย์แนะนำแล้วไม่สามารถควบคุมภาวะไขมันในเลือดสูงได้ แพทย์อาจจะแนะนำให้ผู้ป่วยใช้ยาร่วมด้วย ซึ่งยาที่ใช้สำหรับภาวะไขมันในเลือดสูงมีอยู่หลายกลุ่ม ได้แก่

 

  • ยากลุ่ม statins เช่น , ,ยากลุ่มนี้สามารถลดคอเลสเตอรอลได้ดี ลดไตรกลีเซอไรด์ได้เล็กน้อย
  • ยากลุ่ม fibric acids derivatives เช่น gemfibrozil , fenofibrate , bezafibrate ยากลุ่มนี้สามารถลดไตรกลีเซอไรด์ได้ดี ลดคอเลสเตอรอลได้เล็กน้อย

การจะทราบได้ว่าเรามีภาวะไขมันในเลือดสูงหรือไม่ต้อง จะต้องเจาะเลือดตรวจระดับไขมัน 4 ชนิดคือ LDL , HDL , Triglyceride , Total Cholesterol

การตัดสินใจว่าควรต้องใช้ยาหรือไม่ก็ควรต้องให้แพทย์วินิจฉัย และพิจารณาความเหมาะสมเป็นรายบุคคล ซึ่งขึ้นอยู่กับ ชนิดของไขมันในเลือดที่สูง และภาวะความรุนแรงของโรค ทั้งนี้แพทย์อาจให้ยา กลุ่มใดกลุ่มหนึ่ง หรือมากกว่า 1 กลุ่มร่วมกัน

ในผู้ป่วยบางรายที่มีภาวะของโรคระบบหัวใจและหลอดเลือด อาจให้แอสไพรินร่วมด้วย เพื่อป้องกันการอุดตันของลิ่มเลือด

ผลข้างเคียงของยา

ในผู้ป่วยบางราย การรับประทานยาลดไขมันอาจทำให้เกิดอาการแน่นท้อง คลื่นไส้ ท้องเสียได้ ผู้ป่วยบางรายที่ได้รับยากลุ่ม statins และ fibric acids derivatives อาจต้องตรวจการทำงานของตับเป็นครั้งคราว และบางรายอาจมีอาการปวดเมื่อยกล้ามเนื้อ จนเดินไม่ไหว

ยากลุ่ม nicotinic acid และ analogue อาจทำให้มีอาการคันและร้อนวูบวาบ อาการเหล่านี้ไม่ได้เกิดขึ้นกับผู้ทานยาทุกคน ดังนั้นหากผู้ป่วย มีอาการที่กล่าวถึงข้างต้นมากจนรบกวนการใช้ชีวิตประจำวัน ให้แจ้งแพทย์ประจำตัว หรือเภสัชกรทราบ เพื่อจะได้เปลี่ยนยาให้ ไม่ควรเปลี่ยนยาหรือหยุดยาเองนะคะ

 

Which Medicines Lower “Bad” (LDL) Cholesterol?

IN THIS ARTICLE

When you have high cholesterol, the first thing to do is to change your diet and fitness: less saturated fat, no trans fat, less sugar, and more activity.

If that doesn’t bring down your “bad” (LDL) cholesterol enough, your doctor may suggest that you also take medicine to help out. (You’ll still need to keep up those lifestyle habits.)

There are several different types of prescription drugs that lower LDL. Get to know what each of them does.

 

.

 

 

Targeting Triglycerides: Fibrates

“Fibrates” are drugs that cut down on how much triglycerides your body makes and can also boost your “good” HDL cholesterol.

Examples include:

 

Treatment

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.

The choice of medication or combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effects. Common choices include:

 

Tolerance varies

Tolerance of medications varies from person to person. The common side effects of statins are muscle pains and muscle damage, reversible memory loss and confusion, and elevated blood sugar. If you decide to take cholesterol medication, your doctor might recommend liver function tests to monitor the medication's effect on your liver.

Children and cholesterol treatment

Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol or who are obese. Children age 10 and older who have extremely high cholesterol levels might be prescribed cholesterol-lowering drugs, such as statins.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Lifestyle changes are essential to improve your cholesterol levels. To bring your numbers down, try the following:

  • Lose extra pounds. Losing even 5 to 10 pounds can help lower cholesterol levels.
  • Eat a heart-healthy diet. Focus on plant-based foods, including fruits, vegetables and whole grains. Limit saturated fats, found in red meat and full-fat dairy products, and trans fats, found in many processed foods.

    Monounsaturated fat — found in olive and canola oils — is a healthier option. Avocados, nuts and oily fish are other sources of healthy fat.

  • Exercise regularly. With your doctor's OK, work up to at least 30 minutes of moderate intensity exercise five times a week or vigorous exercise five times a week.
  • Don't smoke. If you smoke, find a way to quit.

Alternative medicine

Few natural products have been proved to reduce cholesterol, but some might be helpful. With your doctor's OK, consider these cholesterol-lowering supplements and products:

  • Barley
  • Plant sterols and stanols, found in oral supplements, some fortified orange juices and some margarines, such as Promise Activ
  • Blond psyllium, found in seed husk and products such as Metamucil
  • Oat bran, found in oatmeal and whole oats

Another popular cholesterol-lowering supplement is red yeast rice. There is evidence that red yeast rice can help lower your LDL cholesterol. However, the Food and Drug Administration has said that red yeast rice products that contain monacolin K, a naturally occurring form of the prescription medication known as lovastatin, can't be sold in the United States.

If you buy red yeast rice supplements in the United States, there's no way to know whether you're getting enough monacolin K to lower your LDL cholesterol. In other countries, lovastatin in red yeast rice products is potentially dangerous because there's no way to know how much might be in a particular product or what the quality of the lovastatin is.

Even if you take cholesterol-lowering supplements, remember the importance of a healthy lifestyle, and take medication to reduce your cholesterol as directed. Tell your doctor which supplements you take.

Preparing for your appointment

If you're an adult who hasn't had regular cholesterol level checks, make an appointment with your doctor. Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. For a cholesterol test, you'll likely have to avoid eating or drinking anything other than water for nine to 12 hours before the blood sample is taken.

Make a list of:

  • Your symptoms, if any
  • Key personal information, including a family history of high cholesterol, coronary artery disease, strokes, high blood pressure or diabetes
  • All medications, vitamins or supplements you take, including doses
  • Questions to ask your doctor

For high cholesterol, some basic questions to ask your doctor include:

  • What tests do I need?
  • What's the best treatment?
  • How often do I need a cholesterol test?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • What's your diet like?
  • How much exercise do you get?
  • How much alcohol do you drink?
  • Do you smoke? Are you or were you around other smokers?
  • When was your last cholesterol test? What were the results?

Self-management of hyperlipidemia through a balanced diet and regular physical activity may help a person reduce levels of lipoproteins in their blood.

However, genetics also determine cholesterol levels, so a healthful lifestyle may not always be enough to reduce cholesterol. Some individuals might require medications.

Typically, doctors prescribe statins, such as simvastatin, lovastatin, atorvastatin, and rosuvastatin, for reducing cholesterol. These medications decrease the amount of cholesterol the liver produces.

Statins can cause side effects, including muscle pain. The muscle pain is usually harmless, but in rare cases, statins can cause muscle damage or breakdown.

Anyone who finds the pain hard to tolerate should talk to their doctor before stopping taking the drugs. It is essential to balance the risk of a cardiovascular event against the risk of side effects before stopping treatment with statins.

People whose cholesterol levels do not reach their desired target after taking statins may need higher doses of statin medications or additional medications. Other non-statin medications include ezetimibe and, less commonly, fibrates or niacin.

New guidelines suggest PCSK9 inhibitors are also available, such as evolocumab (Repatha).

PCSK9 inhibitors can be expensive, so a doctor should take this into account before prescribing them. However, the guidelines recommend a lower price for these medications to allow specific populations access to the drug.

This includes people with inherited hyperlipidemia who may not otherwise be able to take the medicine they need or those who have had a heart attack and cannot achieve their LDL goal with other drugs.

Doctors screen for hyperlipidemia using a lipid profile blood test.

It is usually a fasting test. This means that a person should refrain from eating or drinking anything for 9–12 hours before the test. However, new guidelines are less strict about fasting, so check with your doctor whether you need to fast before the test.

A recent guideline update advised that parents can choose for their children to have a cholesterol screening from 2 years of age if they have a family history of high cholesterol or heart disease.

Most children should undergo a screening between 9–11 years of age and 17–21 years of age.

Cholesterol Medications

Cholesterol Rx bottles

Help to control your cholesterol levels

For some people, lifestyle changes, such as a healthier diet and more exercise, may prevent or treat unhealthy cholesterol levels. For others with high cholesterol, medication may also be needed.

Work with your doctor to develop a treatment plan that’s right for you. If medication is required, be sure to take it as prescribed. The potential benefit to your health is worth making these medications part of your normal routine.

Types of cholesterol-lowering drugs

Various medications can lower blood cholesterol levels.

Statins are recommended for most patients and have been directly associated with a reduction in the risk of heart attack or stroke. Statins continue to provide the most effective lipid-lowering treatment in most cases.

 

Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. We’ve included generic names as well as major trade names to help you identify what you may be taking. Please understand that the American Heart Association is not recommending or endorsing any specific products. If your prescription medication isn’t on this list, your doctor and pharmacist are your best sources of information. It’s important to discuss all the drugs you take with your doctor and to understand their desired effects and possible side effects. Never stop taking a medication or change your dosage (or frequency) without first consulting your doctor. Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your doctor about any potential risks.

Statins

This class of drugs, also known as HMG CoA reductase inhibitors, works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.

Talk to your doctor about the possible side effects before starting statins. Most side effects are mild and go away as your body adjusts. Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests. Women who are pregnant or people who have active or chronic liver disease should not take statins. 

Statins available in the U.S. include:

  • Atorvastatin (Lipitor®)
  • Fluvastatin (Lescol®)
  • Lovastatin (Mevacor®, Altoprev™)
  • Pravastatin (Pravachol®)
  • Rosuvastatin Calcium (Crestor®)
  • Simvastatin (Zocor®)

If statins don’t help you enough, or if you develop side effects, your doctor may recommend different medications.

Statins are also found in the combination medications Caduet® (atorvastatin + amlodipine) and Vytorin™ (simvastatin + ezetimibe).

If you have CVD and are already taking the highest tolerated statin and your LDL-C is still 70 or above, one or more of the following medicines may be prescribed. They all can be taken in combination with a statin.

Ezetimibe (cholesterol absorption inhibitors)

Prevents cholesterol from being absorbed in the intestine. It’s the most commonly used non-statin agent.

Bile Acid Sequestrants

Also called bile acid-binding agents, cause the intestine to get rid of more cholesterol. 

Those available in the U.S. include:

  • Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®, Locholest® Light)
  • Colestipol (Colestid®)
  • Colesevelam Hcl (WelChol®)

PCSK9 inhibitors

PCSK9 inhibitors are powerful LDL-lowering drugs. They bind to and inactivate a protein on cells found in the liver to lower LDL (bad) cholesterol. Some names are alirocumab and evolocumab


The following triglyceride-lowering drugs have mild LDL-lowering action, but data doesn’t support their use as an add on to statins.

Fibrates

Fibrates are especially good for lowering triglyceride (blood fat) levels and have a mild LDL-lowering action. 

Fibrates available in the U.S. include:

  • Gemfibrozil (Lopid®)
  • Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)
  • Clofibrate (Atromid-S)

Niacin (nicotinic acid)

Niacin is a B vitamin that limits the production of blood fats in the liver. Take this only if your doctor has prescribed it. It lowers triglycerides and has mild LDL-lowering action.

Niacin side effects may include flushing, itching and upset stomach. Your liver functions may be closely monitored because niacin can cause toxicity. Nonprescription immediate-release forms of niacin usually have the most side effects, especially at higher doses. Niacin is used cautiously in diabetic patients because it can raise blood sugar levels.

Niacin comes in prescription form and as a dietary supplement. Dietary supplement niacin must not be used as a substitute for prescription niacin because of potentially serious side effects. Dietary supplement niacin is not regulated by the Food and Drug Administration and may contain widely variable amounts of niacin – from none to much more than the label states. The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy.

Omega-3 Fatty Acid Ethyl Esters

These are derived from fish oils that are chemically changed and purified. They’re used in tandem with dietary changes, to help people with high triglyceride levels (over 200 mg/dL).

Omega-3 Fatty Acid Ethyl Esters available in the U.S. include:

  • Lovaza®
  • Vascepa™
  • Epanova®
  • Omtryg®

Marine-Derived Omega-3 Polyunsaturated Fatty Acids (PUFA)

Commonly referred to as omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high blood triglyceride levels. They help decrease triglyceride secretion and clear triglycerides. The amount of marine-derived omega-3 PUFAs needed to significantly lower triglyceride (2 to 4 g) is hard to get from a daily diet alone, so supplementing with capsules may be needed.

Use these supplements only under a doctor’s direction and care, because large doses may cause serious side effects. These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics. Negative interactions with other medications, herbal preparations and nutritional supplements are also possible. People with allergies to fish, shellfish or both may have a severe adverse reaction to using these supplements.

 

 

 

 

 

References 

  1. Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD, La Grenade L. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA. 2004;292:2585-90.
  2. https://www.webmd.com/cholesterol-management/guide/cholesterol-lowering-medication
  3. https://www.healthline.com/health/hyperlipidemia
  4. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications