Pharmacy & Therapeutics - May 2008 - (Page 281) DRUG FORECAST mg/dL, the primary aim is to achieve the goal LDL-C. Statins are preferred; they are safe and efficacious for lowering both LDL-C and TG levels, and they are generally well tolerated. Other options for lowering LDL-C levels include niacin, ezetimibe (Zetia, Merck), and bile acid resins.1 After patients achieve targeted LDL-C levels, if TG levels still exceed 200 mg/ dL, non-HDL (total cholesterol minus HDL) should be calculated. If non-HDL is above goal (LDL-C goal plus 30 mg/dL), either LDL-C or TG values should be lowered. If a patient is taking a statin and if increasing the dose is not effective or is not an option, combination therapy is necessar y. Fibric acids (especially feno fibrate) and niacin are possible options, but Lovaza may also be a reasonable choice; it does not interact with statins or increase the risk of rhabdomyolysis.1 For patients with acquired or genetic disorders of combined hyperlipidemia (e.g., high LDL-C and high TG), combination therapy is required to attain goal lipid levels.1 Based on current information, it is safe to combine Lovaza with a statin to treat dyslipidemia. report. Circulation 2002; 106:3143–3421. Available at: http://circ.ahajournals. org/cgi/content/full/106/ 25/3143. Pownall HJ, Ballantyne CM, Kimball KT, et al. Effect of moderate alcohol consumption on hypertriglyceridemia: A study in the fasted state. Arch Intern Med 1999; 159:981–987. Bang HO, Dyerberg J, Nielsen AB. Plasma lipids and lipoprotein pattern in Greenlandic West Coast Eskimos. Lancet 1971;1(7710):1143–1145. Kris-Etherton PM, Harris WS, Appel LJ, for the Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747–2757. Whelton SP, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol 2004;93:1119–1123. He K, Song Y, Daviglus ML, et al. Accumulated evidence on fish consumption and coronary heart disease mortality: A meta-analysis of cohort studies. Circulation 2004;109:2705–2711. Structures and functions of omega-3 fatty acids. Available at http://en.wikipedia. org/wiki/%CE%91-linolenic_acid; http:// en.wikipedia.org/wiki/Eicosapentaenoic_acid; and http://en.wikipedia.org/ wiki/Docosahexaenoic_ acid. Accessed July 6, 2007. Omega-3. Available at: www.omacorrx. com. Accessed May 17, 2007. Lovaza (Omacor) capsules, prescribing information. Liberty Corner, NJ: Reliant; 2005. Revised August 2007. Bays H. Clinical overview of Omacor: A concentrated formulation of omega-3 polyunsaturated fatty acids. Am J Cardiol 2006;98(Suppl):71i–76i. DHA for eyesight and mental acuity. Family Health News & Nutrition. Available at: www.familyhealthnews.com/articles_ dha_for_eyesight.html. Accessed July 6, 2007. Kris-Etherton PM, Harris WS, Appel LJ, for the AHA Nutrition Committee. Omega-3 fatty acids and cardiovascular disease: New recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol 2003;23:151–152. Data on file. Liberty Corner, NJ: Reliant. Br yhn M, Hansteen H, Schanche T, Aarke SE. The bioavailability and pharmacodynamics of different concentrations of omega-3 acid ethyl esters. Prostaglandins Leukot Essent Fatty Acids 2006; 75:19–24. Mackness MI, Bhatnagar D, Durrington PN, et al. Effects of a new fish oil concentrate on plasma lipids and lipoproteins in patients with hypertriglyceridemia. Eur J Clin Nutr 1994;48:859–865. Lee KW, Lip GY. The role of omega-3 fatty acids in the secondar y prevention of cardiovascular disease. Q J Med 2003;96: 465–480. von Schacky C. A review of omega-3 ethyl esters for cardiovascular prevention and treatment of increased blood triglyceride levels. Vasc Health Risk Manage 2006;2: 251–262. Reiffel JA, McDonald A. Antiarrhythmic effects of omega-3 fatty acids. Am J Cardiol 2006;98(Suppl):50i–60i. Duggal N, Tom WC. New drug: Omacor (omega-3 acid ethyl esters.) Pharmacist’s Letter/Prescriber’s Letter 2005;21. Detail Document No. 211003. Harris WS, Ginsberg HN, Arunakul N, et al. Safety and efficacy of Omacor in severe hypertriglyceridemia. J Cardiovasc Risk 1997;4:385–391. Pownall HJ, Brauchi D, Kilnic C, et al. Correlation of serum triglyceride and its reduction by omega-3 fatty acids with lipid transfer activity and the neutral lipid compositions of high-density and lowdensity lipoproteins. Atherosclerosis 1999; 143:285–297. Stalenhoef AF, de Graaf J, Wittekoek ME, et al. The effect of concentrated n-3 fatty acids versus gemfibrozil on plasma lipoproteins, low-density lipoprotein heterogeneity and oxidizability in patients with hyper triglyceridemia. Atherosclerosis 2000;153:129–138. Van Dam M, Stalenhoef AFH, Wittekoek J, et al. Efficacy of concentrated omega3 fatty acids in hypertriglyceridemia: A comparison with gemfibrozil. Clin Drug Invest 2001;21:175–181. Durrington PN, Bhatnagar D, Mackness MI, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary hear t disease and persisting hyper triglyceridemia. Heart 2001;85:544–548. Nordoy A, Bonaa KH, Nilsen H, et al. Effects of simvastatin and omega-3 fatty acids on plasma lipoproteins and lipid peroxidation in patients with combined hyperlipidemia. J Intern Med 1998;243: 163–170. Calabresi L, Donati D, Pazzucconi F, et al. Omacor in familial combined hyperlipidemia: Ef fects on lipids and lowdensity lipoprotein subclasses. Atherosclerosis 2000;148:387–396. Eritsland J, Arnesen H, Berg K, et al. Serum Lp(a) lipoprotein levels in patients with coronar y arter y disease and the influence of long-term n-3 fatty acid supplementation. Scand J Clin Lab Invest 1995;55:295–300. Grundt H, Nilsen DW, Hetland O, et al. Improvement of serum lipids and blood pressure during inter vention with n-3 fatty acids was not associated with changes in insulin levels in subjects with combined hyperlipidemia. J Intern Med 1995; 237:249–259. Lungerhausen YK, Abbey M, Nestel PJ, Howe PRC. Reduction of blood pressure and plasma triglycerides by omega-3 fatty acids in treated hypertensives. J Hypertens 1994;12:1041–1045. Russo C, Olivieri O, Girelli D, et al. Omega-3 polyunsaturated fatty acid supplementation and ambulatory blood pressure monitoring parameters in patients continued on page 303 Vol. 33 No. 5 • May 2008 • 18. 19. 2. 3. 20. 4. 21. 5. 22. 6. 7. 23. 24. 8. 9. 10. COST The cost of Lovaza is comparable to that of niacin, slightly more than that of fenofibrate, and significantly more than that of gemfibrozil (see Table 2.)47 An increasing number of insurance companies are covering Lovaza, usually in Tier 3 or with a prior authorization.48 25. 11. 26. CONCLUSION Lovaza 4 g daily is an option for the treatment of very high TG levels. Safe and effective, it may reduce the risk of acute pancreatitis and the long-term risk of CVD. Patients using Lovaza should be counseled about compliance with diet and lifestyle modifications. Acknowledgment: The author would like to thank Joan Rider, PharmD, CDE, for reviewing the manuscript. 12. 27. 13. 14. 28. 15. REFERENCES 1. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Adult Treatment Panel III). Final 16. 29. 30. 17. P&T® 281 http://en.wikipedia.org/wiki/%CE%91-linolenic_acid http://en.wikipedia.org/wiki/%CE%91-linolenic_acid http://en.wikipedia.org/wiki/Eicosapentaenoic_acid http://en.wikipedia.org/wiki/Eicosapentaenoic_acid http://en.wikipedia.org/wiki/Docosahexaenoic_ acid http://en.wikipedia.org/wiki/Eicosapentaenoic_acid http://en.wikipedia.org/wiki/Docosahexaenoic_ acid http://www.familyhealthnews.com/articles_dha_for_eyesight.html http://www.familyhealthnews.com/articles_dha_for_eyesight.html
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